Ruptured Disk

Ruptured Disk

Alternate Names

  • slipped disk
  • herniated disk
  • Herniated disk

Definition

A ruptured disk in the back occurs when all or part of a vertebral disk is forced out from between the vertebrae bones of the spinal column, threatening to damage the nerve roots in the vicinity.

What is going on in the body?

The bony 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.

Risks

What are the causes and risks of the condition?

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

Prevention

What can be done to prevent the condition?

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

Diagnosed

How is the condition diagnosed?

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 (NCV), which measures transmission along the nerve
  • an electromyogram (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

Long Term Effects

What are the long-term effects of the condition?

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.

Other Risks

What are the risks to others?

A ruptured disk is not contagious and poses no risks to others.

Treatments

What are the treatments for the condition?

A ruptured disk is generally treated conservatively at first. Initial treatments include:
  • activity limitations
  • anti-inflammatory pain medicine, such as ibuprofen (i.e., Advil, Motrin), ketoprofen (i.e., Oruvail), flurbiprofen (i.e., Ansaid), or naproxen (i.e., Aleve, Naprosyn)
  • application of heat
  • massage
  • muscle relaxants, such as carisoprodol (i.e., Soma)
  • a specialized exercise program
If conservative treatment is not successful, the healthcare professional may recommend surgery. A large study in 2006 concluded that choosing back surgery over exercise to treat a herniated disc generally provides quicker relief, but the difference is minimal and fears related to skipping surgery are unfounded. The study involved more than 1,200 patients at 13 U.S. hospitals found either surgery to remove a bulging back disc or a course of physical therapy both helped ease the pain and discomfort two years after treatment.
Based on patients' responses, surgery tended to provide somewhat more relief than physical therapy, especially at first, for their sciatica and other pain. However the difference was not statistically significant, narrowed over time, and likely was exaggerated because worse-off patients opted for surgery and tended to believe that surgery must be more effective, the study showed.
Widespread concerns that a bulging disc left untreated will result in worsening back problems, neurological deterioration, and numbness and even paralysis of the legs, buttocks or genitals, were shown to be unfounded.
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
  • nucleoplasty, which involves inserting a needle into the disk and applying heat with a special instrument
  • surgery to remove the damaged disk and replace it with an artificial disk
  • spinal fusion, which involves the joining of two or more vertebrae
Many physicians recommend patients obtain a second opinion before having surgery for a ruptured disk.

Side Effects

What are the side effects of the treatments?

Side effects of medicines include allergic reactions and stomach upset. Surgery can be complicated by infection, bleeding, or reactions to anesthesia.

After Treatment

What happens after treatment for the condition?

After conservative treatment of a ruptured disk, a person can usually resume activity as tolerated. Symptoms may recur occasionally, requiring repeated treatment. When surgery relieves symptoms, the person can slowly resume normal activities. Physical therapy can be helpful to teach appropriate body mechanics and lifting techniques.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Rosen's Textbook of Emergency Medicine

Conn's Current Therapy.

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