Ruptured Disc

A ruptured disc, sometimes referred to as a herniated disc, is a common condition that can result in pain and discomfort.

Intervertebral discs, located between spinal vertebrae, act as small cushions that protect the spinal column as it moves and bends. These discs act as shock absorbers that protect the spine from everyday stress. When a ruptured disc occurs, gel-like material from the nucleus pulposus, located at the core of the vertebral disc is released into the spinal canal, causing the nerves to be compressed. Numbness or tingling may result once the disc starts compressing a spinal nerve.

Anatomy

The spine has 24 moveable bones called vertebrae. Each vertebra is separated by discs, which act as shock absorbers preventing the vertebrae from rubbing together. The outer wall is called the annulus fibrosus. Each disc has a gel-filled center called the nucleus pulposus. At each disc, a pair of spinal nerves exits the spinal cord and branches out to your body, allowing messages or impulses to travel back and forth between your brain and your body.

What is a Ruptured Disc

A ruptured disc occurs when the gel-like center of your disc ruptures out through a tear in the disc wall. This irritates the nerves and causes inflammation and swelling.

A ruptured disc can occur in any part of the spine. The more common are on the lower back (lumbar spine), or in the neck (cervical spine). Ruptures in the thoracic region can occur, though are rarer since the thoracic spine is less mobile. Due to the disc’s displacement, the disc presses on spinal nerves, often producing pain.

Causes of a Ruptured Disc

In many cases, a ruptured disc develops due to wear and tear. A single strain or injury can cause a ruptured disc. However, aging plays a big role. Disc material degenerates naturally as we age, which is why a relatively minor strain or movement can cause a disc to rupture. Genetics, smoking, and a number of occupational and recreational activities lead to early disc degeneration.

A ruptured disc can also arise from spinal stenosis, which is when your spinal canal starts to narrow as part of the natural aging process. This usually occurs in adults 50 and older, leading to pain and other problems. Also, patients with a congenital spinal deformity are prone to a ruptured disc, since their malformation creates pressure on different points throughout the spine that can cause a ruptured disc.

The loss of fluid in your disc may often cause degenerative disc disease, which is the term used to describe the normal changes in your spinal discs as you age. Degenerative disc disease causes your discs to become softer, which can cause a ruptured disc.

Sudden injury, such as those that occur in a car accident, high-impact sports, or a hard fall can also cause a ruptured disc. On the other hand, lack of regular exercise can also cause weakening of the spine, as well as, malnutrition, obesity, and the excessive use of alcohol.

Symptoms of a Ruptured Disc

Symptoms can differ from patient to patient. Usually individuals notice changes when the displaced disc begins to aggravate surrounding components of the body creating nerve pain.

Some of the symptoms many experience are:

  • Spasms
  • Muscle tightness
  • Tingling
  • Weakness in the affected area
  • Pain that goes through the shoulders, arms or down the legs

Because some of these symptoms mirror other spine conditions, it is important to get a comprehensive diagnosis.

In some rare cases, a ruptured disc can start compressing the spinal cord itself, in which case can be very dangerous and should be handled as an emergency.

Diagnosis

Diagnosis is made by a neurosurgeon based on symptoms, history, physical examination, and imaging studies. After reviewing your medical history, your doctor evaluates your current symptoms and what makes them better or worse. Further examination determines how severe the condition is. The different tests can offer more information on locating the rupture, assess the degree of the rupture, and confirm the diagnosis.

Exams & Tests

After a primary diagnosis has been made, different exams and tests will confirm the diagnosis, including:

  • X-ray: X-rays of the spine are obtained to find other potential causes of pain like tumors, infections, fractures, etc.
  • CT scan: A computed tomography scan shows the shape and size of the spinal canal, its contents, and the structures around it.
  • MRI: This test produces a 3-D image of your body structure which shows the spinal cord, nerve roots, and surrounding areas.
  • Myelogram: A contrast injection into the surrounding cerebrospinal fluid spaces shows where there is pressure on the spinal cord or nerves due to a ruptured disc, bone spurs or tumors.

Treatment for a Ruptured Disc

Many patients find relief with conservative non-surgical treatment. However, if your body doesn’t respond to conservative treatment or your symptoms worsen, a surgical intervention may be required.

Non-Surgical Treatment

In most cases, the pain will get better within a couple of days and completely resolve within 4 to 6 weeks. Ice/heat therapy, and taking over the counter medications can help with recovery. Most common non-surgical treatments include:

  • Prescribed medication
  • Physical therapy
  • Holistic therapy
  • Epidural injections of cortisone
  • Hot/Cold therapy
  • Laser therapy
  • Ultrasound therapy

Surgical Treatment

When symptoms progress rapidly or your body is non-responsive to treatment, surgery may be required. There are a lot of factors to consider before choosing a surgical intervention, such as age, the severity of the problem, other medical problems, and other spine interventions. If surgery is recommended, your doctor may perform any of the following surgical approaches:

  • Foraminotomy
  • Laminectomy/Laminotomy
  • Discectomy
  • Partial Pediculectomy

Prevention & Self-Care

After the patient has recovered from surgery and with the doctor’s approval, moderate exercise may be resumed. However, prevention and self-care are crucial to keep and enhance your spine health. Consider implementing the following recommendations:

  • Moderate regular exercise
  • Use correct lifting and moving techniques
  • Maintain correct posture
  • Avoid smoking
  • Avoid stressful situations
  • Maintain a healthy weight