Disc Ruptures

Ruptured Disc Overview

Ruptured disc is also known as herniated disc, slipped disc, bulging disc, or prolapsed disc. The spine is made up vertebrae, which are separated by soft spinal discs that cushion the vertebrae, permit flexibility and absorb shocks to the spine. The discs have a hard casing and a gel-like center. The front area of each vertebra is known as the vertebral body.

In the case of ruptured disc, one of the discs is bulging beyond the edges of the vertebral bodies above and below it. The gel material leaks, irritating nearby nerves. This can cause intermittent or continuous low back pain or sciatica, in which pain typically radiates into the leg and down to the foot. Although the lower back (lumbar area) is typically involved, ruptured disc can sometimes affect the cervical discs of the neck. Slipped discs are often the result of age and wear and tear on the body. The spinal discs become less elastic over the years and can become brittle and cracked.

There are three types of disc ruptures.

Prolapse: the disc is bulging out between the vertebrae, but its outer layer is still in tact.
Extrusion: there is a tear in the outer layer of the spinal disc, causing disc tissue to leak. The leaking tissue remains connected to the disc.
Sequestration: leaked spinal disc tissue has entered the spinal canal and is no longer directly attached to the disc.

Wellstar neurologists and neurosurgeons are experts at diagnosing and treatment ruptured disks. Because many conditions can cause back pain, it’s important to visit your physician so that he or she can analyze your specific symptoms and determine whether you have a herniated disk or disks.

Most patients experience a significant improvement after several weeks. During that time nonsurgical treatment can help relieve symptoms.

Symptoms

Once the nucleus of the disk breaks (herniates) through the outer ring, lower back pain may improve. But sciatic leg pain is likely to increase. That’s because the leaking gel inflames the spinal nerves and may put pressure on them.

In addition to back and leg pain, other symptoms of a ruptured disc can include:

Numbness or tingling sensation in the leg and/or foot
Weakness in the leg and/or foot
Spasm of the lower back muscles
Decrease in knee or ankle reflexes
Pain may worsen after standing or sitting; at night; when sneezing, coughing or laughing; and when bending backward or walking more than a few yards
In rare cases patients will experience a loss of bladder or bowel control. This may indicate a more serious condition known as cauda equina syndrome, which requires immediate medical attention. It occurs when the spinal nerve roots are compressed.
In some cases a herniated disk is not pressing on a nerve, it may cause only low level of back pain, or no pain at all. May not need medical attention or evaluation, just the patient’s vigilance.

Risk Factors

One of the primary risk factors for herniated disc is aging—the effects of wear and tear on the spine over time. There are other more controllable risk factors that influence your chance of having this condition.

Other risk factors:

Being a man. Men between age 30 and 50 are most likely to experience a disc rupture.
Improper lifting. It is possible to rupture a disc by using the back muscles to lift heavy objects rather than the legs..
Other occupational tasks. Heavy exertion, twisting and turning, lifting or pulling heavy objects or repetitive activities that strain the spine can contribute to disc rupture.
Weight. Being overweight puts extra stress on the discs of the lower back.
Nutrition. Inadequate nutrition can contribute to poor disc health.
Frequent or excessive driving. Sitting for long periods of time is hard on the spine and discs. Drivers have the additional hazard of vibration from the vehicle engine.
Sedentary habits. Living a sedentary lifestyle weakens the muscles and increases body weight and reduces circulation. All these factors can contribute to disc degeneration.
Poor posture. Poor posture and bad body mechanics can put additional stress on the spine.
Smoking. Tobacco use can reduce the ability of the disks to absorb needed nutrients and may increase sensitivity to pain.

Ruptured Disc Prevention

Although there is nothing you can do to prevent aging, there are lifestyle and activity choices that can help reduce the change of having a herniated disc. These include:

Stop smoking or don’t start.
Maintain a healthy weight to avoid excess strain on the spine. That includes a diet rich in fruits and vegetables and getting regular exercise for flexibility and strengthening.
Always use proper lifting techniques, including using your leg muscles, not the muscles of the back.
Practice good posture when you walk, stand, sit and sleep.

Ruptured Disc Diagnosis

A visit to your Wellstar neurologist or physician can help determine if your pain is coming from a herniated disc or other sources. The doctor will ask questions about your symptoms and lifestyle, will take a complete medical history. They will also conduct a physical examination as well as a neurological examination to check for weakness or sensory loss.

The doctor may ask you to sit, stand and walk on your toes and heels; bend forward, backward, and to the side; move the neck; and raise your shoulders, elbow, wrist, and hand while checking your strength.

The doctor will also check for leg pain down the leg and below the knee that occurs when you sit on the exam table and lift your leg straight up. This is known as a “straight leg raise” test and is considered an accurate indicator of disc herniation in patients under age 35.

Tools and Tests

Wellstar physicians use a variety of diagnostic imaging tests to make a more definitive diagnosis of ruptured disc. Those include:

Electromyography (EMG) to determine the exact nerve root that is involved.
Myelogram uses dye injected into the area around the spinal cord and nerves to determine the size and location of disc herniation.
Nerve conduction velocity test.
Magnetic resonance imaging (MRI) or spine computed tomography (CT) to indicate that the disc is pressing on the spinal canal.
X-ray of the spine to rule out other cause of pain. X-ray alone cannot diagnose a herniated disc.

Ruptured Disc Treatment

Patients with ruptured or herniated discs often experience a reduction in pain with non-surgical care over a period of several days to several weeks. Many patients are pain free within several months.

Non-surgical Treatments

Your Wellstar doctor will usually recommend conservative treatments like:

Rest. No more than one to two days of bed rest may help calm severe pain from a ruptured disc. It is not advised to stay off your feet for a longer time. All movements should be slow and controlled. Avoid bending, lifting and other actions that can cause additional discomfort. Gradually return to regular activities.
Medications. Your doctor may start by recommended nonprescription pain relief medications like aspirin, ibuprofen, naproxen or acetaminophen. Non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen help reduce swelling and inflammation. Be sure to ask your doctor before taking any medication. Narcotics may be prescribed if pain is severe and does not respond to NSAIDs. If you have back spasms muscle relaxants may be recommended.
Physical therapy. Wellstar offers exceptional physical therapy services at a variety of convenient locations. Your doctor will discuss this option with you.
Epidural steroid injection. Your neurologist may recommend an injection to reduce symptoms if they persist for several weeks. Wellstar pain specialists are expert in delivering these injections.
Relaxation, exercise and positioning (legs raised).
Alternative treatments.

Surgery

If non-surgical approaches have not proven successful, your doctor may recommend diskectomy or partial diskectomy to remove all or part of a herniated disc. The goal of surgery is to cause the ruptured disc to stop pressing on and irritating the nerves.

There are many factors to consider before making the decision. Your neurosurgeon will have answers to your questions about issues like recovery time, what kind of result you can expect, relevant research and activity before and after the procedure.

Many patients experience considerable improvement, especially in leg pain, with diskectomy surgery. Although the risk of surgical complications is low, some patients experience infection, nerve damage, recurrent herniation and other complications.

In rare cases a large disc herniation presses on nerves that control the bladder and bowel, causing loss of control of these functions. This is usually accompanied by numbness and tingling in the groin or genital area. This is one of the few indications that immediate surgery is needed. If you experience any of these symptoms, call your Wellstar physician immediately.

Ongoing Care for Ruptured Disc

Most patients with a ruptured or herniated disc experience considerable relief over days/weeks and can largely return to regular activity. Depending on your situation it can take months to a year or more to be completely pain free. People whose occupations include heavy lifting or other strenuous activity may need to alter their job tasks to avoid re-injury.

Smoking Cessation

Quitting smoking is one of the most important and challenging steps in effective ongoing care.