Disc prolapse

What is disc prolapse?

A disc prolapse, also called a slipped, herniated or bulging disc, happens when the soft, jelly-like centre of one of the discs between your spinal bones pushes out through a tear in its tougher outer layer. This can press on a nearby nerve, causing pain.

‘Slipped disc’ is a common but slightly misleading name, since the disc doesn’t actually slip out of place, and it can’t be popped back in either. It’s most common in the lower back (lumbar spine), and can also happen in the neck (cervical spine) or, less often, the middle back (thoracic spine).

Not everyone with a disc prolapse has symptoms. Estimates vary, but somewhere between 30–50% of healthy people may have one without knowing it.

What are the symptoms of disc prolapse?

Symptoms depend on where the disc is and whether it’s pressing on a nerve, and often only affect one side of your body.

If the prolapse is in your lower back, you might notice:

• lower back pain, which can be a dull ache or a sharp, burning pain
• pain radiating into your buttock, thigh, calf or foot, sometimes called sciatica
• numbness or tingling in your leg or foot
• weakness, such as difficulty lifting your foot, that might make you stumble
• pain that’s worse when sitting, bending, coughing or sneezing

If the prolapse is in your neck, you might notice similar symptoms in your shoulder, arm and hand instead, including pain that feels sharp, burning or electric, and weakness gripping or lifting objects.

You can have a disc prolapse without any symptoms at all. Some people only find out when they have a scan for something else.

Signs of cauda equina syndrome: a medical emergency Call 999 or go to A&E immediately if you have back pain along with any of the following:

• numbness around your bottom or genitals
• inability to pee
• loss of feeling in one or both legs
• loss of control over when you pee or poo
• these symptoms starting after a serious accident

Do not drive yourself to A&E. Ask someone to drive you or call 999 for an ambulance.

What are the causes of disc prolapse and who is at risk?

Disc prolapse is usually the result of gradual, age-related wear and tear. As discs lose moisture and flexibility over time, they become more prone to tearing, even with a fairly minor strain or twist. Sometimes a specific event triggers it, such as lifting a heavy object using your back rather than your legs, twisting while lifting, or a fall or blow to the back, but often there’s no obvious reason.

Factors that can raise your risk include:

• being overweight, which puts extra pressure on the discs in your lower back
• a physically demanding job involving repetitive lifting, pulling, pushing, bending or twisting
• frequent driving, where prolonged sitting combines with vehicle vibration
• an inactive lifestyle
• smoking, which is thought to reduce the oxygen supply to your discs
• a family history of disc problems
• being male: men are affected somewhat more often than women
• connective tissue conditions, such as Ehlers-Danlos or Marfan syndrome (inherited conditions that affect the body’s connective tissue), and diabetes

Disc prolapse is rare in children and most common in younger and middle-aged adults, roughly from your 30s to your 50s.

Are there different types of disc prolapse?

Disc prolapse is usually grouped by where it happens in your spine:

• Lumbar disc prolapse, in your lower back, is by far the most common type. Around 95% happen at one of the two lowest levels of the spine.
• Cervical disc prolapse happens in your neck.
• Thoracic disc prolapse, in your mid-back, is rare

Are there different stages of disc prolapse?

There’s no formal staging system, but the condition tends to follow a general pattern. Pain is usually most severe in the first couple of weeks, then gradually eases over the following weeks as the disc settles and any pressure on the nerve reduces.

Signs that a disc prolapse is healing usually appear gradually, and can include:

• pain becoming duller, less frequent, or more centred near your spine rather than radiating outwards
• improved mobility, such as bending, walking or sitting more comfortably
• less numbness or tingling
• fewer muscle spasms
• needing less pain medication
• returning strength in any previously weakened muscles

How is a disc prolapse diagnosed?

You’ll usually be diagnosed from your symptoms and a physical examination, which may include:

• checking for tenderness along your spine and your range of motion
• a straight leg raise test, where your leg is gently lifted while you lie flat; pain radiating down the leg can suggest nerve compression
• a neurological examination of your reflexes, muscle strength, walking and sensation

X-rays don’t show discs directly but can help rule out fractures or other causes. If your symptoms don’t improve, or the diagnosis is unclear, you may be referred for:

• an MRI scan, the most reliable way to see a disc prolapse and any nerve involvement
• a CT scan, if MRI isn’t suitable
• a myelogram, where dye is injected around your spinal nerves before a CT scan
• nerve conduction studies or electromyography (EMG), which test how well your nerves and muscles are working

How is a disc prolapse treated?

Non-surgical treatment

Most people, around 3 in 4, improve with conservative treatment alone, usually within 2–8 weeks, though it can take longer, especially if a nerve is significantly affected.

• Stay active: keep gently moving with activities like walking, swimming or yoga. Prolonged bed rest can make your back stiffer and weaker.
• Painkillers: anti-inflammatory painkillers such as ibuprofen, taken regularly rather than only when pain is severe, can help you keep moving. A pharmacist can advise on stronger short-term options if needed.
• Muscle relaxants, or medicines for nerve-related pain such as gabapentin or pregabalin, may be prescribed for a limited time.
• Physiotherapy: targeted exercises to strengthen your core, stretches, and manual therapy can help with both symptoms and longer-term recovery.
• Manual therapies such as osteopathy may help ease lower back pain for some people, though you’ll usually need to arrange and pay for this privately.

If symptoms persist, injections may be considered, such as an epidural steroid injection or a nerve root block, delivering anti-inflammatory medicine or anaesthetic close to the affected nerve.

Surgical treatment

Surgery is usually only considered if conservative treatment over several weeks hasn’t helped, or if you have worsening weakness, numbness, or bladder or bowel symptoms. Around 1 in 4 people don’t improve enough with conservative treatment alone and may need referral to a specialist. Options include:

1. Microdiscectomy: a minimally invasive operation, usually under general anaesthetic and taking around 1 hour, to remove the prolapsed fragment of disc and free the nerve. Around 80 - 90% of people have their symptoms substantially relieved, though around 5 - 8% develop another prolapse at some point in the future.
2. Discectomy: removing the damaged disc more fully to relieve pressure on the nerve.
3. Laminotomy or laminectomy: removing part or all of a section of bone (the lamina) to access and decompress the affected nerves.
4. Spinal fusion: joining two or more vertebrae together to stabilise the spine, sometimes done after a disc is removed.
5. Artificial disc replacement: replacing the damaged disc with a synthetic one to help preserve movement at that level of the spine.

When should I see a doctor?

See a GP if you have back or neck pain and:

• painkillers aren’t helping, or the pain isn’t improving after a few weeks
• you have a high temperature, or feel hot, cold or shivery
• you have unexplained weight loss
• there’s swelling in your back
• the pain is worse at night
• you have numbness, tingling or weakness in your arms or legs

Call 999 or go to A&E immediately if you have back pain along with numbness around your bottom or genitals, can’t pee, lose feeling in one or both legs, lose control of your bladder or bowel, or if it started after a serious accident.