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Disc Herniation
Dydyk AM, Ngnitewe Massa R, Mesfin FB.

Continuing Education Activity

A herniated disc is a condition affecting the spine in which the annulus fibrosus is damaged enabling the nucleus pulposus (which is normally
located within the center of the disc) to herniate. This can compress the nerves or spinal cord causing pain and spinal cord dysfunction. This
activity illustrates the evaluation and management of disc herniation and explains the role of the interprofessional team in improving care for
patients with this condition.

Objectives:

Identify the degeneration of the nucleus pulposus in the etiology of disc herniation.
Describe the pathophysiology of disc herniation.
Outline the straight leg raise test and the contralateral (crossed) straight leg raise test in the physical examination of those with disc
herniation.
Summarize the importance of collaboration and communication among the interprofessional team to enhance care coordination for
patients affected by a disc herniation.

Access free multiple choice questions on this topic.

Introduction
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back
pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. Unlike mechanical
back pain, herniated disc pain is often burning or stinging, and may radiate into the lower extremity. Furthermore, in more severe cases, there can
be associated with weakness or sensation changes. In the spine, a disc or a nucleus pulposus is localized between vertebral bodies. It supports the
spine by acting as a shock-absorbing cushion. In some instances, a herniated disc injury can compress the nerve or the spinal cord that causes
pain consistent with nerve compression or spinal cord dysfunction, also known as myelopathy. Herniated discs can be very painful.
Unfortunately, there are limited effective conservative treatment modalities with significant effectiveness. Within a few weeks, most cases of
painful disc herniation heal. In many instances, the herniation of the disc does not cause that patient any pain. Herniated discs are often seen on
MRIs of asymptomatic patients. Imaging is not indicated in a patient with signs and symptoms of a stable herniated disc until six weeks of
persistent symptoms. MRI is the imaging modality of choice. Most cases of herniated disc heal conservatively, but refractory cases may require
interventional procedures or surgical repair. Epidural corticosteroid injections are effective pain relievers for disc herniation in the short term,
while discectomy is more effective than conservative management until one year following surgery [1][2][3]. Providers need to remain aware of
treating the patient with a herniated disc and monitor for severe or rapidly progressing neurological changes; this would be an indication for
urgent neurosurgical referral.

Etiology
An intervertebral disc is composed of annulus fibrous—the annulus fibrous, dense collagenous ring encircling the nucleus pulposus. Disc
herniation occurs when part or all the nucleus pulposus protrudes through the annulus fibrous. The most common cause of disc herniation is a
degenerative process in which, as humans age, the nucleus pulposus becomes less hydrated and weakens. This process will lead to a progressive
disc herniation that can cause symptoms. The second most common cause of disc herniation is trauma. Other causes include connective tissue
disorders and congenital disorders such as short pedicles. Disc herniation is most common in the lumbar spine, followed by the cervical spine.
There is a higher rate of disc herniation in the lumbar and cervical spine due to the biomechanical forces in the flexible part of the spine. The
thoracic spine has a lower rate of disc herniation[4][5].

The pathophysiology of herniated discs is believed to be a combination of the mechanical compression of the nerve by the bulging nucleus
pulposus and the local increase in inflammatory chemokines.

A herniation is more likely to occur posterolaterally, where the annulus fibrosus is thinner and lacks structural support from the anterior or
posterior longitudinal ligaments. Due to its proximity, a posterolateral herniation is more likely to compress the nerve root. On the other hand,
spinal cord compression and clinical myelopathy can occur if there is a herniation of a large midline disc. The localized back pain is a
combination of the herniated disc pressure on the longitudinal ligament, and chemical irritation due to local inflammation.

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Epidemiology
The incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in people in their third to the fifth decade
of life, with a male to female ratio of 2:1 [6]. The estimated prevalence of symptomatic herniated disc of the lumbar spine is about 1-3 percent of
patients. The prevalence is most significant among 30-50-year-olds. The patients between 25-55 years old have an approximately 95 percent
chance of herniated discs occurring either at L4-L5 or L5-S1 [7]. Disc disease is the underlying etiology in less than five percent of patients with
back pain [8].

History and Physical

There are characteristic findings to herniated discs all along the vertebrae. The patient will likely recall an inciting injury, often due to lifting or
twisting. Furthermore, pain can be described as sharp or burning. There is often radiation of the pain in the distribution of the compressed nerve
root. Numbness and tingling, as well as decreased sensation along the path of the nerve root, may also occur. In more severe cases, weakness or a
feeling of instability while ambulating may be endorsed.

Cervical Spine

History

In the cervical spine, the C6-7 is the most common herniation disc that causes symptoms, mostly radiculopathy. History in these patients should
include the chief complaint, the onset of symptoms, where the pain starts and radiates. History should include if there are any past treatments.[9]

Physical Examination

On physical examination, particular attention should be given to weaknesses and sensory disturbances, and their myotome and dermatomal
distribution. The examiner should also pay attention at this point to any sign of spinal cord dysfunction.

Table 1: Typical findings of solitary nerve lesion due to compression by a herniated disc in the cervical spine

C5 Nerve - neck, shoulder, and scapula pain, lateral arm numbness, and weakness during shoulder abduction, external rotation, elbow
flexion, and forearm supination. The reflexes affected are the biceps and brachioradialis.

C6 Nerve - neck, shoulder, scapula, and lateral arm, forearm, and hand pain, along with lateral forearm, thumb, and index finger
numbness. Weakness during shoulder abduction, external rotation, elbow flexion, and forearm supination and pronation is common. The
reflexes affected are the biceps and brachioradialis.

C7 Nerve - neck, shoulder, middle finger pain are standard, along with the index, middle finger, and palm numbness. Weakness on the
elbow and wrist are common, along with weakness during radial extension, forearm pronation, and wrist flexion may occur. The reflex
affected is the triceps.

C8 Nerve - neck, shoulder, and medial forearm pain, with numbness on the medial forearm and medial hand. Weakness is common
during finger extension, wrist (ulnar) extension, distal finger flexion, extension, abduction, and adduction, along with distal thumb
flexion. No reflexes are affected.

T1 Nerve - pain is common in the neck, medial arm, and forearm, whereas numbness is common on the anterior arm and medial
forearm. Weakness can occur during thumb abduction, distal thumb flexion, finger abduction, and adduction. No reflexes are affected.

Thoracic Spine

Intervertebral disc degeneration often causes thoracic discogenic pain syndrome. Thoracic disc lesions mostly affect the lower part of the thoracic
spine. Three-quarters of incidence occurs below T8, and T11-T12 are most common.

History

Most thoracic disc herniations are asymptomatic and discovered incidentally with an MRI.Unlike the lumbar and cervical disc herniations,
thoracic disc herniations have atypical symptoms and often a diagnosis of exclusion.

Physical Examination

Patients may have sensory changes. Serious findings include gait disturbances, paralysis, cardiovascular abnormalities.

Lumbar Spine

History

In the lumbar spine, a herniated disc can present with symptoms including sensory and motor abnormalities limited to a specific
myotome. History in these patients should include chief complaints, the onset of symptoms, where the pain starts and radiates. History should
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include if there are any past treatments.

Physical Examination

A careful neurological examination can help in localizing the level of the compression. The sensory loss, weakness, pain location, and reflex loss
associated with the different levels are described in Table 2.

Table 2. Typical findings of solitary nerve lesion due to compression by a herniated disc in the lumbar spine

L1 Nerve - pain and sensory loss are common in the inguinal region. Hip flexion weakness is rare, and no stretch reflex is affected.

L2-L3-L4 Nerves - back pain radiating into the anterior thigh and medial lower leg; sensory loss to the anterior thigh and sometimes
medial lower leg; hip flexion and adduction weakness, knee extension weakness; decreased patellar reflex.

L5 Nerve - back, radiating into buttock, lateral thigh, lateral calf, and dorsum foot, great toe; sensory loss on the lateral calf, dorsum of
the foot, webspace between first and second toe; weakness on hip abduction, knee flexion, foot dorsiflexion, toe extension and flexion,
foot inversion and eversion; decreased semitendinosus/semimembranosus reflex.

S1 Nerve - back, radiating into buttock, lateral or posterior thigh, posterior calf, lateral or plantar foot; sensory loss on the posterior calf,
lateral or plantar aspect of foot; weakness on hip extension, knee flexion, plantar flexion of the foot; Achilles tendon; Medial buttock,
perineal, and perianal region; weakness may be minimal, with urinary and fecal incontinence as well as sexual dysfunction.

S2-S4 Nerves - sacral or buttock pain radiating into the posterior aspect of the leg or the perineum; sensory deficit on the medial
buttock, perineal, and perianal region; absent bulbocavernosus, anal wink reflex.

The straight leg raise test: With the patient lying supine, the examiner slowly elevates the patient's leg at an increasing angle, while keeping the
leg straight at the knee joint. The test is positive if it reproduces the patient's typical pain and paresthesia.[10]

The contralateral (crossed) straight leg raise test: As in the straight leg raise test, the patient is lying supine, and the examiner elevates the
asymptomatic leg. The test is positive if the maneuver reproduces the patient's typical pain and paresthesia. The test has a specificity higher than
90%.

Evaluation
Over 85% of patients with symptoms associated with an acute herniated disc will resolve within 8 to 12 weeks without any specific treatments.
However, patients who have an abnormal neurological examination or are refractory to conservative treatments will need further evaluation and
treatments[11][12][13].

X-rays: These are very accessible at most clinics and outpatient offices. This imaging technique can be used to assess for any structural
instability. If x-rays show an acute fracture, it needs to be further investigated using a computed tomogram (CT) scan or magnetic resonance
imaging (MRI).

CT Scan: It is the preferred study to visualize bony structures in the spine. It can also show calcified herniated discs. It is less accessible in office
settings compared to x-rays. But it is more convenient than MRI. In the patients that have non-MRI comparable implanted devices, CT
myelography can be performed to visualize herniated disc.

MRI: It is the preferred and most sensitive study to visualize herniated disc. MRI findings will help surgeons and other providers plan procedural
care if it is indicated.

Treatment / Management
Conservative Treatments

Acute cervical and lumbar radiculopathies due to a herniated disc are primarily managed with non-surgical treatments. NSAIDs and physical
therapy are first-line treatment modalities. Physical therapy is not recommended on the initial onset of symptoms. Most cases of disc herniation
resolve within a few weeks after the onset of symptoms; thus, it is not recommended to start physical therapy until symptoms have lasted for at
least three weeks. These are excellent modalities for managing disabling pain. Patients who fail conservative treatment or patients with
neurological deficits need timely surgical consultation. [14][15][16][17] There is limited evidence in the use of muscle relaxers such as
cyclobenzaprine or oral corticosteroids [18]. For cases of severe pain unresponsive to over-the-counter pain medication, opioid analgesics are
warranted. However, the side effect profile, risk, and benefits of the medicine should be discussed with the patient, and opioids should be
prescribed for the shortest duration possible. Translaminar epidural injections and selective nerve root blocks are the second-line modalities for
patients unresponsive to conservative management and who have had symptoms for at least four to six weeks. There is limited evidence of the
efficacy of epidural injections beyond three months, but repeat injections are often considered as well [19][20].

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Surgical Treatments

As always, surgical treatment is the last resort. Surgical procedures for a herniated disc include laminectomies with discectomies depending on
the cervical or lumbar area. Also, a patient with a herniated disc in the cervical spine can be managed via an anterior approach that requires
anterior cervical decompression and fusion. An artificial disk replacement option can be considered. Other alternative surgical procedures to
the lumbar spine include a lateral or anterior approach that requires complete discectomy and fusion. The benefits of surgical intervention are
moderate and tend to decrease over time following surgery [21].

Differential Diagnosis
The differential diagnoses for a herniated disc include:

Discal cyst
Mechanical back pain
Degenerative spinal stenosis
Epidural abscess
Epidural hematoma
Metastasis
Diabetic amyotrophy
Neurinoma
Osteophytes
Cauda equina syndrome
Synovial cyst

Prognosis
Studies vary on outcomes of herniated disc prognosis. But the majority of cases respond to conservative management. One study did show that
30% of patients complain of back pain at one year [22]. It should also be mentioned that many cases of disc herniation are asymptomatic and
found inadvertently on advanced imaging. Of symptomatic cases, 90% of them resolve at six weeks following injury. Surgery may lead to more
rapid recovery of the symptomatic herniated disc, but results are also similar to conservative management at one year post-operatively [23][24]
[23].

Complications
Complications of a herniated disc include the development of chronic back pain. Furthermore, untreated cases of disc herniation, albeit rare, can
lead to lasting nerve damage in severe nerve root compression. Most examples of discectomy are successful in the surgical repair of a herniated
disc, but some cases do require repeat intervention. Economically symptomatic herniated discs can lead to significant loss of work and disability.
A severe complication of surgery or interventional procedures is rare, but cases of paralysis and death have been recorded in the literature.

Deterrence and Patient Education

Thoracic spine herniated disc usually presents with radiculopathy symptoms or myelopathic symptoms depending on the compression of the
nerve roots or spinal cord, respectively.

Patients may complain of burning pain, numbness and tingling, sensation changes, or weakness.

The vast majority of cases resolved with conservative management.

In the cervical (neck) and lumbar (low back) spine, patients initially are managed conservatively with over-the-counter pain medications, home
exercises, heat, ice, and activity as tolerated.

The time of recovery often depends on the mechanism of injury, as well as the severity of disc herniation. On average, most cases of disc
herniation resolve between two to twelve weeks following injury.

Since many cases improve within two to three weeks following injury, physical therapy is not recommended until three weeks after the onset of
symptoms.

Similarly, given that most cases resolve within six weeks of symptoms. An MRI is not recommended until at least six weeks of persistent
symptoms, symptoms of severe radiculopathy, or rapidly worsening neurological changes associated with a suspected disc herniation.

A patient who has progressive myelopathic symptoms or does not respond to conservative treatment can be managed with an epidural steroid
injection or radiofrequency ablative techniques.

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The surgical approach for the thoracic spine includes the transthoracic or costotransversectomy approach for discectomies and fusion.

Enhancing Healthcare Team Outcomes

Disc herniation is a common problem encountered by the primary care provider, nurse practitioner, emergency department physician, and
internist. The management of disc herniation is not satisfactory, and thus an interprofessional team needs to be involved. The initial treatment
should be conservative unless a patient has a severe neurological compromise. The patient's pain is often managed with acetaminophen and non-
steroidal anti-inflammatories. However, some cases due require opioid analgesics. A pharmacist should monitor the duration and dosage of opioid
analgesics. Surgery is usually the last resort, as it does not always result in predictable results. Patients are often left with residual pain and
neurological deficits, which are often worse after surgery. Physical therapy is vital for most patients. For refractory cases, MRI interpretation is
needed by a radiologist.

Furthermore, cases unresponsive to conservative management may require either the expertise of a Pain Medicine specialist in stable cases or a
neurosurgeon in unstable instances. Back pain can be a significant cause of morbidity and is often associated with mental health disorders.
Chronic back pain is associated with depression and should be managed accordingly by the primary care or mental health provider. The outcomes
depend on many factors, but those who participate in regular exercise and maintain a healthy body weight have better results than people who are
sedentary[25][1][26][6].

Review Questions
Access free multiple choice questions on this topic.
Comment on this article.

Figure
Cervical Spine MRI. Axial view of a herniated disc in the cervical region. Contributed by Scott Dulebohn, MD

Figure
Lumbar Spine MRI, Disc Herniation Contributed by Scott Dulebohn, MD

Figure
Straight Leg Test sometimes used to help diagnose a herniated disc Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN,
CPEN

References
1. Sharma SB, Kim JS. A Review of Minimally Invasive Surgical Techniques for the Management of Thoracic Disc Herniations. Neurospine.
2019 Mar;16(1):24-33. [PMC free article: PMC6449820] [PubMed: 30943704]
2. Huang R, Meng Z, Cao Y, Yu J, Wang S, Luo C, Yu L, Xu Y, Sun Y, Jiang L. Nonsurgical medical treatment in the management of pain due to
lumbar disc prolapse: A network meta-analysis. Semin Arthritis Rheum. 2019 Oct;49(2):303-313. [PubMed: 30940466]
3. Tang C, Moser FG, Reveille J, Bruckel J, Weisman MH. Cauda Equina Syndrome in Ankylosing Spondylitis: Challenges in Diagnosis,
Management, and Pathogenesis. J Rheumatol. 2019 Dec;46(12):1582-1588. [PubMed: 30936280]
4. Park CH, Park ES, Lee SH, Lee KK, Kwon YK, Kang MS, Lee SY, Shin YH. Risk Factors for Early Recurrence After Transforaminal
Endoscopic Lumbar Disc Decompression. Pain Physician. 2019 Mar;22(2):E133-E138. [PubMed: 30921991]
5. Huang JS, Fan BK, Liu JM. [Overview of risk factors for failed percutaneous transforaminal endoscopic discectomy in lumbar disc
herniation]. Zhongguo Gu Shang. 2019 Feb 25;32(2):186-189. [PubMed: 30884940]
6. Fjeld OR, Grøvle L, Helgeland J, Småstuen MC, Solberg TK, Zwart JA, Grotle M. Complications, reoperations, readmissions, and length of
hospital stay in 34 639 surgical cases of lumbar disc herniation. Bone Joint J. 2019 Apr;101-B(4):470-477. [PubMed: 30929479]
Conteúdo licenciado para Emanoel Adao Pacheco - 088.873.349-60
https://www.ncbi.nlm.nih.gov/books/NBK441822/?report=reader 5/7
 11/01/2024, 20:18 Disc Herniation - StatPearls - NCBI Bookshelf
7. Jordan J, Konstantinou K, O'Dowd J. Herniated lumbar disc. BMJ Clin Evid. 2009 Mar 26;2009 [PMC free article: PMC2907819] [PubMed:
19445754]
8. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients
with chronic low back pain. Spine (Phila Pa 1976). 1995 Sep 01;20(17):1878-83. [PubMed: 8560335]
9. Dydyk AM, Khan MZ, Singh P. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Oct 24, 2022. Radicular Back Pain.
[PubMed: 31536200]
10. M Das J, Nadi M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 27, 2023. Lasegue Sign. [PubMed: 31424883]
11. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019
Apr;43(4):853-859. [PubMed: 30767043]
12. Hassan KZ, Sherman AL. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 17, 2023. Epidural Steroids. [PubMed:
30726005]
13. Johnson SM, Shah LM. Imaging of Acute Low Back Pain. Radiol Clin North Am. 2019 Mar;57(2):397-413. [PubMed: 30709477]
14. Brazilian Medical Association. Silvinato A, Simões RS, Buzzini RF, Bernardo WM. Lumbar herniated disc treatment with percutaneous
hydrodiscectomy. Rev Assoc Med Bras (1992). 2018 Sep;64(9):778-782. [PubMed: 30672996]
15. Harper R, Klineberg E. The evidence-based approach for surgical complications in the treatment of lumbar disc herniation. Int Orthop. 2019
Apr;43(4):975-980. [PubMed: 30543041]
16. Lavi ES, Pal A, Bleicher D, Kang K, Sidani C. MR Imaging of the Spine: Urgent and Emergent Indications. Semin Ultrasound CT MR.
2018 Dec;39(6):551-569. [PubMed: 30527521]
17. Alvin MD, Lubelski D, Alam R, Williams SK, Obuchowski NA, Steinmetz MP, Wang JC, Melillo AJ, Pahwa A, Benzel EC, Modic MT,
Quencer R, Mroz TE. Spine Surgeon Treatment Variability: The Impact on Costs. Global Spine J. 2018 Aug;8(5):498-506. [PMC free
article: PMC6149049] [PubMed: 30258756]
18. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Denberg TD, Barry
MJ, Boyd C, Chow RD, Fitterman N, Harris RP, Humphrey LL, Vijan S. Noninvasive Treatments for Acute, Subacute, and Chronic Low
Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 04;166(7):514-530.
[PubMed: 28192789]
19. Landau WM, Nelson DA, Armon C, Argoff CE, Samuels J, Backonja MM. Assessment: use of epidural steroid injections to treat radicular
lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
Neurology. 2007 Aug 07;69(6):614; author reply 614-5. [PubMed: 17679685]
20. Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, Sullivan SD, Jarvik J. Epidural Corticosteroid Injections for Radiculopathy
and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Sep 01;163(5):373-81. [PubMed: 26302454]
21. Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer
WO, Wall EM., American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary
rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976). 2009
May 01;34(10):1066-77. [PubMed: 19363457]
22. Amlie E, Weber H, Holme I. Treatment of acute low-back pain with piroxicam: results of a double-blind placebo-controlled trial. Spine
(Phila Pa 1976). 1987 Jun;12(5):473-6. [PubMed: 2957801]
23. Schoenfeld AJ, Weiner BK. Treatment of lumbar disc herniation: Evidence-based practice. Int J Gen Med. 2010 Jul 21;3:209-14. [PMC free
article: PMC2915533] [PubMed: 20689695]
24. Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized
study. J Bone Joint Surg Am. 2004 Apr;86(4):670-9. [PubMed: 15069129]
25. Heo DH, Sharma S, Park CK. Endoscopic Treatment of Extraforaminal Entrapment of L5 Nerve Root (Far Out Syndrome) by Unilateral
Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results. Neurospine. 2019 Mar;16(1):130-137. [PMC free article:
PMC6449829] [PubMed: 30943715]
26. Shen Z, Zhong ZM, Wu Q, Zheng S, Shen X, Chen J. Predictors for Poor Outcomes After Percutaneous Endoscopic Lumbar Discectomy: A
Retrospective Study of 241 Patients. World Neurosurg. 2019 Jun;126:e422-e431. [PubMed: 30825632]

Disclosure: Alexander Dydyk declares no relevant financial relationships with ineligible companies.

Disclosure: Ruben Ngnitewe Massa declares no relevant financial relationships with ineligible companies.

Disclosure: Fassil Mesfin declares no relevant financial relationships with ineligible companies.

Publication Details

Author Information and Affiliations

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Authors

Alexander M. Dydyk1; Ruben Ngnitewe Massa2; Fassil B. Mesfin3.

Affiliations

1
Abrazo Central Campus
2 University of Missouri
3
MU School of Medicine

Publication History

Last Update: January 16, 2023.

Copyright
Copyright © 2023, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) (
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Publisher

StatPearls Publishing, Treasure Island (FL)

NLM Citation

Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2023 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

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