Ruptured Disc

A healthy disc is a small, ring-shaped structure that fits between the bones in your spine (vertebrae). It serves as a cushion for the bones during movement and help transfer pressure from one bone to the next. Discs are composed of a soft center (nucleus pulposus) surrounded by a strong band of cartilage (annulus fibrosus). The center has a jelly-like texture in children, which becomes more rigid with age.

When a disc herniates, or ruptures, the soft center bulges out of the ring of cartilage into the spinal canal. Due to the limited space in the canal, the fragment may press on the nearby nerve.

Causes
Ruptures may occur from overloading the discs, which are commonly damaged from falls, overuse, or sudden twisting movements. They can also herniate suddenly without an obvious cause. Obesity, weak back muscles, poor posture, smoking, and improper body mechanics can increase your risk of a disc herniation.

Symptoms
In the lower back (lumbar region), pain is felt in one or both legs. This condition is sometimes referred to as sciatica. Sitting and standing are usually very uncomfortable. You also may experience weakness, numbness and tingling in your legs. In serious cases, bowel and bladder function can be affected. Herniated discs typically do not cause back pain.

Diagnosis
Your doctor will ask you about your symptoms and the history of the problem. A physical examination will help to reveal tender areas and problems with movement and reflexes. X-rays may be used to rule out other conditions, such as a tumor, infection or a broken bone. MRI (magnetic resonance imaging) can be used to gain a clearer view of the disc, as well as check the health of other discs. An EMG (electromyography) study may be utilized to learn more about the location and extent of nerve and muscle damage.

Treatment
Typically, conservative treatments are employed for approximately the first 6 weeks. During this time, your doctor may recommend:

• rest and reduced activity to help ease pressure on the area, which will decrease inflammation
• nonsteroidal anti-inflammatory medications to minimize swelling and decrease pain or steroids
• epidural steroid injection, which places medication directly beside the nerve to reduce inflammation
• muscle relaxants
• supervised therapy sessions with a physical and/or occupational therapist.

Surgical treatment may be necessary if conservative measures are unsuccessful. Part of the disc may need to be removed. Talk to your doctor about the different procedures that may be used.

Outlook
Many patients respond well to conservative treatment. Those who do require surgery are often back to work in about 6 weeks or less. After you have had a disc herniation, you are at risk for the problem returning in the same disc or at another level.

Prevention
Practicing good posture and body mechanics during all daily activities is important to the health of your back. Be sure to monitor your body throughout the day to check for proper alignment of your head, shoulders and trunk. Avoid twisting your back when carrying out tasks. When picking up a heavy object, hold the item close to your body and use your legs, not your back, to power the lifting.

Physical conditioning is also necessary in protecting your back. Regular exercise will keep your muscles flexible and strong. Exercise will also help you maintain a healthy weight, which is important in controlling the stress placed on your spine. Stopping smoking is also helpful.