周围有一些亲戚朋友得了“椎间盘突出症（herniated disk）”，于是翻译这篇梅奥诊所的这篇介绍文章，希望有所帮助。

但是请千万注意，我的翻译可能会有不准确的地方。另外，此文章不能代替专业医学诊断治疗，请谨慎参考。最重要的是，有问题一定要去看医生，和医生沟通。

总览（Overview）

A herniated disk refers to a problem with one of the rubbery cushions (disks) that sit between the individual bones (vertebrae) that stack to make your spine.

突出的椎间盘，指的是置于脊柱（spine）中的骨头（椎骨vertebrae）之间的一个橡胶垫（即椎间盘disk）的问题。

A spinal disk has a soft, jellylike center (nucleus) encased in a tougher, rubbery exterior (annulus). Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the nucleus pushes out through a tear in the annulus.

一个椎间盘有着柔软、果冻一样的中心（核），被一个更坚硬、橡胶样的外壳（环）所包裹。有时，我们叫做“滑盘”或者是“破裂盘”。椎间盘突出指的是，当有一些“核”通过“环”中的液体突出去了。【译者注：此处医学术语翻译的很不准确】

A herniated disk, which can occur in any part of the spine, can irritate a nearby nerve. Depending on where the herniated disk is, it can result in pain, numbness or weakness in an arm or leg.

椎间盘突出刺激周围的神经，可以发生在脊柱的任何一个部分。根据发生突出部位的不同，可以导致胳膊或者是腿的疼痛，麻木，或者是虚弱。

Many people have no symptoms from a herniated disk. Surgery is usually not necessary to relieve the problem.

许多人发生椎间盘突出但没有症状。缓解问题的手术不是经常必要的。

症状（Symptoms）

Most herniated disks occur in the lower back, although they can also occur in the neck. Signs and symptoms depend on where the disk is situated and whether the disk is pressing on a nerve. They usually affect one side of the body.

大多数的椎间盘突出发生在后背的下部分，尽管有时也发生在颈部。出现的迹象和症状往往依赖于椎间盘的位置，和是否椎间盘压迫神经了。经常是身体的一侧会收到影响。

  • Arm or leg pain. If your herniated disk is in your lower back, you’ll typically feel the most pain in your buttocks, thigh and calf. You might have pain in part of the foot, as well. If your herniated disk is in your neck, you’ll typically feel the most pain in your shoulder and arm. This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions. Pain is often described as sharp or burning.
  • Numbness or tingling. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves.
  • Weakness. Muscles served by the affected nerves tend to weaken. This can cause you to stumble, or affect your ability to lift or hold items.
  • 手臂和腿疼：如果椎间盘突出发生在后背下部分，你通常会感觉臀部，大腿和小腿最疼。你也许还会感觉脚的一部分也疼。如果椎间盘突出发生在颈部，你通常会感觉到肩膀和胳膊最疼。疼痛可能会“射向”你的肩膀和腿，当你咳嗽，擤鼻涕或者是移动到特定姿势的时候。疼痛往往被形容成尖疼或者是灼烧痛。
  • 麻木和刺痛：有椎间盘突出的人经常会在神经受影响的部位有散发状的麻木或者是刺痛。
  • 虚弱：神经受影响的部位的肌肉会变得虚弱。这会引起你摔倒，或者是影响你提东西的能力。

You can have a herniated disk without symptoms. You might not know you have it unless it shows up on a spinal image.

你是有可能有椎间盘突出但是没有症状的。你也许不知道你有，除非在你的脊柱影像中看到。

什么时候去看医生（When to see a doctor）

Seek medical attention if your neck or back pain travels down your arm or leg, or if you also have numbness, tingling or weakness.

当你的颈部或者是后背疼痛，蔓延到你的胳膊或者是腿的时候，或者是当你还有麻木，刺痛或者是虚弱的症状的时候，去寻求医生的注意。

病因（Causes）

Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your disks become less flexible and more prone to tearing or rupturing with even a minor strain or twist.

椎间盘突出往往是长期，年龄相关磨损的结果，被称为椎间盘老化。当你年龄增长，你的椎间盘柔韧性变差，更易撕裂或者破裂，有时哪怕是一点的抻或者是扭。

Most people can’t pinpoint the cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back is the cause.

大多数人是无法指出椎间盘突出的原因的。有时人们知道，使用背部肌肉，而非腿部/大腿肌肉提重物会导致椎间盘突出，因为扭到了。很少的情况下，是由于创伤性事件引起的，例如跌倒或者是后背吹到了。

危险因素（Risk factors）

Factors that can increase your risk of a herniated disk include:

  • Weight. Excess body weight causes extra stress on the disks in your lower back.
  • Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also can increase your risk of a herniated disk.
  • Genetics. Some people inherit a predisposition to developing a herniated disk.
  • Smoking. It’s thought that smoking lessens the oxygen supply to the disk, causing it to break down more quickly.

能够增加你椎间盘突出风险的因素包括：

  • 体重。过高的体重会导致后背下部分的椎间盘受到更大的压力
  • 职业。体力消耗大的工作，往往会增加背部问题的风险。反复的提，拉，推，屈身和拧也会提高风险。
  • 遗传。
  • 抽烟。人们认为，抽烟会减少椎间盘的氧气输送，从而引起损坏更快。

并发症（Complications）

Just above your waist, your spinal cord ends. What continues through the spinal canal is a group of long nerve roots that resemble a horse’s tail (cauda equina).

你的脊髓在就在你腰部上方停止。紧接着，你椎管里是一组长神经末梢，像马尾一样。

Rarely, disk herniation can compress the entire spinal canal, including all the nerves of the cauda equina. Rarely, emergency surgery might be required to avoid permanent weakness or paralysis.

椎间盘突出很少能够压迫整个椎管，包括马尾部的神经。很少需要紧急手术去避免永久疼痛或者是麻痹。

Seek emergency medical attention if you have:

  • Worsening symptoms. Pain, numbness or weakness can increase to the point that they hamper your daily activities.
  • Bladder or bowel dysfunction. Cauda equina syndrome can cause incontinence or difficulty urinating even with a full bladder.
  • Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.

如果你有以下症状，请去需求紧急医学关注：

  • 更严重的症状。疼痛，麻木或者是虚弱到影响了你每天的活动。
  • 膀胱或肠功能障碍。马尾神经综合症，会引起尿失禁，或者是即使充满膀胱也会排尿困难。
  • 马鞍式感觉丧失：这个渐进性的感觉丧失会影响你接触马鞍的部位，即大腿内侧，腿后部和直肠周围。

预防（Prevention）

To help prevent a herniated disk, do the following:

  • Exercise. Strengthening the trunk muscles stabilizes and supports the spine.
  • Maintain good posture. This reduces pressure on your spine and disks. Keep your back straight and aligned, particularly when sitting for long periods. Lift heavy objects properly, making your legs — not your back — do most of the work.
  • Maintain a healthy weight. Excess weight puts more pressure on the spine and disks, making them more susceptible to herniation.
  • Quit smoking. Avoid the use of any tobacco products.

想要帮助预防椎间怕突出，你可以做：

  • 锻炼：增加躯干肌肉稳定性，支持你的脊柱
  • 保持良好姿势：这会降低对脊柱和椎间盘的压力。保证你的后背直和贴合，尤其是长时间坐着的时候。适当的提重物，使用你的腿而不是你的背去做大部分的工作。
  • 健康的体重
  • 戒烟

诊断（Diagnosis）

During the physical exam, your doctor will check your back for tenderness. You might be asked to lie flat and move your legs into various positions to help determine the cause of your pain.

在身体检查时，你的医生会检查你的背部的压痛。你也许会被要求躺平，移动腿到不同的位置，以帮助判断疼痛引起的原因。

Your doctor may also perform a neurological exam to check your:

  • Reflexes
  • Muscle strength
  • Walking ability
  • Ability to feel light touches, pinpricks or vibration

你的医生也许还会做一些神经学的检查：

  • 反射
  • 肌肉强度
  • 走路能力
  • 感受轻触，针刺或者是振动的能力

In most cases of herniated disk, a physical exam and a medical history are all that’s needed for a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.

对于大多数的椎间盘突出，诊断只需要一个物理检查和一个病史询问。如果你的医生怀疑你有其他的情况或者是需求，去检查你的神经是否受到影响，他也许会要求更多的检查。

影像检测（Imaging tests）

  • X-rays. Plain X-rays don’t detect herniated disks, but they can rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
  • CT scan. A CT scanner takes a series of X-rays from different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
  • MRI. Radio waves and a strong magnetic field are used to create images of your body’s internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.
  • Myelogram. A dye is injected into the spinal fluid before X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
  • X光片。普通的X光片无法检测椎间盘突出，但是可以排除其他导致背痛的原因，例如感染，肿瘤，脊柱对齐的问题，或者是骨折。
  • CT扫描。CT扫描会在不同方向进行一系列的X光片检测，然后将这些影像合并，创造出你脊柱的横向和它周围结构的图像。
  • MRI核磁共振成像。无线电波和强磁场会产生出你身体内部结构的影像。这些检测可以用于确定你椎间盘突出的位置，和哪些神经受到影响。
  • 脊髓造影。在X光片进行之前，染料将会注射到你的脊柱液中。这个检测可以显示你脊髓和脊神经由于多处椎间盘突出或者其他原因而受到的压力。

神经检测（Nerve tests）

Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of nerve damage.

肌电图和神经传导研究，可以测量你的电脉冲在神经组织中传导的好坏。这可以帮助定位神经受损部位。

  • Nerve conduction study. This test measures electrical nerve impulses and functioning in your muscles and nerves through electrodes placed on your skin. The study measures the electrical impulses in your nerve signals when a small current passes through the nerve.
  • Electromyography (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they’re at rest.
  • 神经传导研究。这个检测会在皮肤上放置电极，测量你肌肉和神经中的电神经脉冲和功能。
  • 肌电图：医生会将针状的电极透过皮肤插入到你不同的肌肉部位，以评估你在解除和休息时肌肉的电流活动。

治疗（Treatment）

Conservative treatment — mainly modifying activities to avoid movement that causes pain and taking pain medication — relieves symptoms in most people within a few days or weeks.

保守治疗 - 主要是通过避免引起疼痛的移动，或者是服用止痛药。大多数人会在几天或者是几周内症状缓解。

药物（Medications）

  • Over-the-counter pain medications. If your pain is mild to moderate, your doctor might recommend over-the-counter pain medication, such as acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
  • Cortisone injections. If your pain doesn’t improve with oral medications, your doctor might recommend a corticosteroid that can be injected into the area around the spinal nerves. Spinal imaging can help guide the needle.
  • Muscle relaxers. You might be prescribed these if you have muscle spasms. Sedation and dizziness are common side effects.
  • Opioids. Because of the side effects of opioids and the potential for addiction, many doctors hesitate to prescribe them for disk herniation. If other medication doesn’t relieve your pain, your doctor might consider short-term use of opioids, such as codeine or an oxycodone-acetaminophen combination (Percocet, Roxicet). Sedation, nausea, confusion and constipation are possible side effects from these drugs.
  • 非处方止痛药。如果你的疼痛是轻度到中度的，你的医生也许会推荐你一些非处方止痛药，例如对乙酰氨基酚（泰诺，其他），布洛芬（Advil，Motrin IB，其他）或萘普生钠（Aleve）。
  • 可的松注射。如果你的疼痛无法通过口服药物缓解，你的医生也许会推荐你皮质类固醇，它可以直接被注射到脊神经周围的区域。脊柱的影像会帮助引导这个注射。
  • 肌肉放松剂。你也许会给一些处方药，如果你的肌肉痉挛。镇静和头晕会是常见的副作用。
  • 阿片类药物。因为阿片类药物的副作用和潜在的成瘾性，许多医生会犹豫是否要给椎间盘突出的患者开处方。如果其他药物无法缓解你的疼痛，你的医生也许可以考虑短期使用阿片类药物，例如可待因或羟考酮-对乙酰氨基酚组合物（Percocet，Roxicet）。镇静，恶心，意识模糊和便秘可能是这些药物的副作用。

治疗（Therapy）

Your doctor might suggest physical therapy to help with your pain. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.

你的医生也许会建议进行一些物理治疗以帮助缓解你的疼痛。物理治疗师会告诉你练习的位置和动作，以使你椎间盘突出引起的疼痛最小。

手术（Surgery）

Few people with herniated disks eventually need surgery. Your doctor might suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to have:

  • Poorly controlled pain
  • Numbness or weakness
  • Difficulty standing or walking
  • Loss of bladder or bowel control

很少椎间盘突出的人最终会需要手术。你的医生也许会推荐手术，如果保守治疗在6周后无法改善你的症状，尤其是你持续的有：

  • 控制不好的疼痛
  • 麻木或者虚弱
  • 站立或者行走困难
  • 膀胱或者是肠道失控

In nearly all cases, surgeons can remove just the protruding portion of the disk. Rarely, the entire disk must be removed. In these cases, the vertebrae may need to be fused with a bone graft.

在绝大多数的情况下，手术可以移除椎间盘突出部分。极少的情况下，需要移除整个椎间盘。那种情况下，椎骨需要与植骨融合。

To allow the process of bone fusion, which takes months, metal hardware is placed in the spine to provide spinal stability. Rarely, your surgeon might suggest the implantation of an artificial disk.

骨头愈合可能需要数月时间，金属硬件会被放在脊柱中以提供稳定性。很少的情况下，你的手术会建议植入一个人造椎间盘。

生活方式和在家治疗（Lifestyle and home remedies）

Besides taking the pain medications your doctor recommends, try:

除了使用你医生推荐给你的止疼药，你还可以尝试：

  • Applying heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you might switch to gentle heat to give relief and comfort.
  • Avoiding too much bed rest. Staying in bed can lead to stiff joints and weak muscles — which can complicate your recovery. Instead, rest in a position of comfort for 30 minutes, and then go for a short walk or do some work. Try to avoid activities that worsen your pain.
  • Resuming activity slowly. Let your pain guide you in resuming your activities. Make sure your movements are slow and controlled, especially bending forward and lifting.
  • 热敷或者是冷敷。开始的时候，冰袋可以用来缓解疼痛和炎症。过几天后，你也许可以改成使用温热来缓解和舒适。
  • 避免过多的床上休息。呆在床上会导致硬关节和弱肌肉，这会使得你的恢复变复杂。相反，你应该以一种姿势休息30分钟，然后去走一走或者是做点其他工作。但要试图避免做使你疼痛加剧的活动。
  • 缓慢的恢复活动。让你的疼痛来引导你缓慢的恢复你的活动。保证你的运动是缓慢的，可控的，尤其是向前弯曲和提东西的时候。

其他治疗（Alternative medicine）

Some alternative and complementary medicine treatments might help ease chronic back pain. Examples include:

  • Chiropractic. Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.
  • Acupuncture. Although results are usually modest, acupuncture appears to ease chronic back and neck pain.
  • Massage. This hands-on therapy can provide short-term relief to people dealing with chronic low back pain.

其他的一些治疗手段和补充药物治疗也许会帮助你缓解慢性的背部疼痛。例子包括：

  • 整脊。脊椎手术被发现对于持续至少一个月的腰痛是中等有效的。很少情况下，颈部的脊椎治疗会引起某些类型的中风。
  • 针刺。针刺会缓解慢性背和颈疼，尽管可能是中度的。
  • 按摩。这个随手的治疗可以提供短期的疼痛缓解，对于那些慢性背下部疼痛的人。

为你的就诊作准备（Preparing for your appointment）

You’re likely to start by seeing your family doctor. You might be referred to a doctor specializing in physical medicine and rehabilitation, orthopedic surgery, neurology, or neurosurgery.

你也许开始要看你的家庭医生了。你也许会被转诊到物理医学和康复，骨外科，神经病学或神经外科等的专科医生那里。（译者注：国外一般是多级诊疗制度，先去看家庭医生（中国也有翻译为全科医生），再去看专科大夫。但目前国内，人们更习惯于直接去看专科大夫，而家庭医生制度尚未普及）。

你可以做什么（What you can do）

Before your appointment, be prepared to answer the following questions:

  • When did your symptoms start?
  • Were you lifting, pushing or pulling anything at the time you first felt symptoms? Were you twisting your back?
  • Has the pain kept you from participating in activities?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What medications or supplements do you take?

在预约钱，请准备好回答以下问题：

  • 什么时候症状开始的？
  • 症状开始时，是否提，推，或者是拉什么东西？是否扭到了后背？
  • 疼痛是否影响了你的活动？
  • 哪些症状在改善？
  • 哪些症状在恶化？
  • 哪些药物或者是保健品你在使用？

你从医生那里期待什么（What to expect from your doctor）

Your doctor might ask other questions, including:

  • Does your pain travel into your arms or legs?
  • Do you feel weakness or numbness in your arms or legs?
  • Have you noticed changes in your bowel or bladder habits?
  • Does coughing or sneezing worsen your leg pain?
  • Is the pain interfering with sleep or work?
  • Does your work involve heavy lifting?
  • Do you smoke or otherwise use tobacco products?
  • How has your weight changed recently?

你的医生有可能问你其他的问题，包括：

  • 疼痛是否蔓延到你的腿或者胳膊？
  • 你是否感到腿和胳膊麻木或者是虚弱？
  • 你有没有注意到肠或膀胱行为的改变？
  • 咳嗽或者是醒鼻子会否加重你的腿疼？
  • 疼痛会否影响睡眠或者是工作？
  • 你的工作是否会涉及到提重物？
  • 你是否抽烟或者使用其他烟草制品？
  • 你的体重最近有什么变化吗？