A ruptured disk in the back occurs when all or part of a vertebral disk is forced through the bones of the spinal column.
The vertebrae of the spinal column are separated by vertebral disks that act like shock absorbers. A disk is made up of two parts. The outer ring or annulus is a tough, fibrous material. The inner part or nucleus is a soft, jelly-like material. A ruptured disk occurs when the outer ring tears or breaks, allowing the jelly-like material to poke through the crack. The disk may press on nerves, causing pain and loss of function.
The location of the ruptured disk determines where a person will have symptoms. Most ruptured disks are in the lower back and cause low back pain. The ruptured disk may press on the sciatic nerve. This pressure causes sciatic nerve dysfunction. The person may experience the following symptoms: · decreased ability to flex the knee · decreased ability to move the foot and toes in certain directions · numbness, burning, or tingling in the leg · pain in the lower back that may travel to the back of the thigh and calf
If the ruptured disk is in the upper back, the symptoms may be in the shoulder, arm, or hand.
There are many causes of a ruptured disk. Repeated heavy lifting is the most common cause, especially when improper lifting techniques are used. Many people who have a ruptured disk are involved in manual labor jobs. Other risk factors for disk rupture include: · activities, such as driving a car, that pass vibrations along the spine · lack of physical activity · obesity · old age · smoking
Proper lifting techniques are important to avoid a ruptured disk. These techniques can be enhanced by the use of an abdominal support belt. Other preventive measures include the following: · regular physical activity · rest breaks to interrupt long periods of vibration, such as when driving a car · smoking cessation for individuals who smoke · weight management for people who are obese
Diagnosis of a ruptured disk begins with a medical history and physical exam. Depending on the suspected cause of the problem, the provider may order diagnostic tests, such as: · CT or MRI scans · blood and urine tests · a nerve conduction velocity test, or NCV, which measures transmission along the nerve · an electromyogram, or EMG, which measures muscle response to nerve stimulation · a bone scan · a myelogram, which uses a contrast agent and X-rays to detect abnormalities along the spine
Chronic pain from an untreated ruptured disk can result in depression, lack of productivity, and drug abuse. If the ruptured disk presses on a nerve, the person may have weakness, numbness, and loss of muscle mass.
A ruptured disk is not contagious and poses no risks to others.
A ruptured disk is generally treated conservatively at first. Initial treatments include: · activity limitations · anti-inflammatory pain medicine, such as ibuprofen, ketoprofen, flurbiprofen, or naproxen · application of heat · massage · muscle relaxants, such as carisoprodol · a specialized exercise program
If conservative treatment is not successful, the healthcare provider may recommend surgery. The following operations may be helpful for people with a ruptured disk: · diskectomy or laminectomy, which allows the surgeon to remove the ruptured disk and relieve nerve pressure · injection of chymopapain, an enzyme, into the disk to dissolve it · nucleoplasty, which involves inserting a needle into the disk and applying heat with a special instrument · spinal fusion, which involves the joining of two or more vertebrae
Side effects of medicines include allergic reactions and stomach upset. Surgery is associated with a risk of infection, bleeding, and allergic reaction to anesthesia.
After conservative treatment of a ruptured disk, a person can usually resume activity as tolerated. Symptoms may recur every now and then, requiring repeated treatment. Ninety percent of the time, surgery relieves symptoms, and the person can slowly resume normal activities. Physical therapy can be helpful to teach appropriate body mechanics and lifting techniques.
Any new or worsening symptoms should be reported to the healthcare provider.