Prolapsed Intervertebral Disk (PIVD)

PIVD, or Prolapsed Intervertebral Disc, is a condition that occurs when the material inside a spinal disc bulges or ruptures through the outer layer and compresses the nerves in the spinal canal. This can cause pain, numbness, weakness, and other symptoms.

PIVD can be caused by age-related wear and tear, injury, or degenerative conditions. Treatment options range from conservative measures like rest and physical therapy to more invasive procedures like surgery. If you suspect you may have PIVD, it’s important to seek medical attention to determine the best course of action for your specific case.

Diagram of herniated disc or prolapsed intervertebral disk


The herniated disk also known as the prolapsed intervertebral disk is a condition affecting the spine frequently causing neck pain or back pain. The intervertebral disk is a disc-shaped circular tissue present between the adjacent vertebrae. The disk acts as a cushion between two vertebrae and provides stability.

Anatomy of the Intervertebral disk

The intervertebral disks consist of a thick fibrous outer layer known as the annulus and a soft center known as the nucleus pulposus. The outer layer adjoining the vertebrae is known as the endplate. The endplate is formed by cartilage that contributes to the growth of the vertebra. The endplate is thick in childhood and gradually decreases in thickness.

The annulus fibrosis consists of concentric layers of thick fibers which imparts it the property of elasticity while being tough. The nucleus pulposus has a watery gel-like consistency giving it the ability to resist compression and allow cushioning action. The sinuvertebral nerve arises from the dorsal root ganglion and supplies the most superficial layer of the annulus fibrosis.

MRI of the lumbar spine in the sagittal section showing disc bulge.

MRI of the lumbar spine in the sagittal section showing disc bulge.


A disc herniation results from the protrusion/extrusion of the nucleus pulposus through the annulus fibrosis of the disk. The vertebral canal has only enough room for the spinal cord/spinal nerves and the spinal fluid. The herniated disk causes inflammation and impinges/compresses the nerves/spinal cord causing symptoms of pain.

Classification based on anatomy

The herniated disc may either occur in the form of protrusion where the nucleus pulposus is still covered by a thin layer of the annulus fibrosis. In the case of disk extrusion, the nucleus pulposus herniates through the annulus fibrosis but is still contained within the disc space. In cases where the herniated nucleus pulposus loses contact with the original disk material, it is known as disk sequestration.

MRI image showing multiple disc herniations.

MRI image showing multiple disc herniations.


Classification based on location

The disk may herniate centrally known as central disk herniation. The disk material commonly compresses the spinal cord and in severe cases may result in cauda equina syndrome. Most frequently, the disk material herniated to the sides known as posterolateral/paracentral disk herniation.

In paracentral disk herniation descending nerve roots are commonly compressed leading to symptoms of pain in the area supplied by the nerve. Less commonly, the disk may herniate at extreme sides known as foraminal (far lateral) herniation. In foraminal herniation, the nerve exiting the foramen is impinged leading to symptoms.

Axial section of the spine showing central disc herniation.

Axial section of the spine showing central disc herniation.


Prolapsed Intervertebral Disk Causes

The herniated disk in the majority of the cases occur in the lower back (lumbar spine) and the rest of the cases involve the neck (cervical spine). The prolapsed intervertebral disk is more common in adults aged 30 and more as with age the nucleus pulposus starts losing the water content, making it more susceptible to injuries.

Repetitive activities such as bending, turning, twisting may cause tears in the annulus. Obesity, smoking, and improper posture while sitting or standing to make the disks more vulnerable to injuries resulting in PIVD. Lifting weights and traumatic injuries frequently result in PIVD.

Prolapsed Intervertebral Disk Symptoms

The symptoms of a herniated disk depend on the location of the herniation and the amount of compression on the neural structures. In the lower back, a herniated disk commonly results in pain of the lower back. The patients may also experience shooting pains in the buttocks radiating to the back of the legs and feet. Some patients may complain of numbness and tingling of the feet or legs. Patients may also experience weakness of the legs or feet.

Cauda equina syndrome results from compression of the nerve roots from a large central disk herniation below the L1-L2 vertebrae. The compression of the sac below this level may result in loss of bowel bladder control, numbness of the saddle area. The condition is an emergency and requires immediate surgery. 

The symptoms from disk herniation in the neck may result in pain in the region between the neck and the shoulders. The patients may experience radiating pain down the shoulders, arm, forearm, and hand. There may be numbness and tingling in the region supplied by the impinged nerve. The patients may complain of weakness of the muscles of the hand, forearm, arm, or shoulders depending upon the location of the impingement.

Prolapsed Intervertebral Disk Diagnosis

The diagnosis of a herniated disk is made by your examining physician. An extensive history is obtained regarding the onset of the symptoms and the activities leading to the symptoms. The physician will usually perform an extensive physical examination. The physical examination consists of different tests used to illicit the symptoms to localize the area of herniation. The physician will also assess the motor and sensory functions of the limbs.

Prolapsed Intervertebral Disk Management

The vast majority of the cases of prolapsed intervertebral disks respond to conservative/non-surgical treatment. The conservative management consists of rest and avoidance of activities precipitating the pain.

Nonsteroidal anti-inflammatory medication and muscle relaxants provide significant relief in the majority of the patients. Cold therapy provides symptom relief and heat therapy helps once the spasm has decreased.

The herniated disc material is slowly reabsorbed by the body which results in relief of the nerve impingement. Therefore most patients experience significant relief over a period of months. Once the pain subsides, the patients are advised to physical therapy to strengthen the muscles around the spine for providing better stability.

In cases, patients are unable to participate in physical therapy due to pain, epidural or foraminal steroid injection is given to provide relief from symptoms.

Rarely patients whose symptoms are not relieved with conservative therapy may require surgical intervention. Surgical management of lumbar disk herniations commonly consists of Microdiskectomy which is usually performed on an outpatient basis.

The surgery involves the use of a microscope to aid in performing the surgery through a very small incision in the back. The surgery involves the removal of the herniated disk and any part impinging upon the nerve root.

In the case of cervical disk herniation, surgical management usually consist of a fusion of the two adjoining vertebrae in addition to the removal of the disc material.

Shavers used for removing intervertebral disc material

Shavers used for removing intervertebral disc material



Instruments used for lumbar spinal fusion

Instruments used for lumbar spinal fusion


The instruments in the image above are used to remove the intervertebral disc material, create raw surface for the insertion of the bone cage and insert the pedicle screws.

Distraction forceps and TLIF cages

Distraction forceps and TLIF cages


The transforaminal lumbar interbody fusion (TLIF) utilizes a lateral incision from the back for fusion of the vertebrae. The image above shows distraction forceps used to create a space between the vertebra for insertion of the bone cage along with the bone graft material for aiding the fusion of the involved segment.

Call Us Now!

Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.