What is Ruptured Disc?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Your doctor’s just given the news: The back pain is due to a disc rupture in the spine. It sounds pretty bad on its own, but what does this actually mean for you?

Picture the spinal column and you’ll see 33 vertebrae–stacked bones that lend strength and mobility to the rest of the body–from the base of the skull all the way down to the pelvis. These bodies also serve as both a protective home for the spinal cord and a highway for branching nerve roots.

Between these bones are cushion-like pads known as intervertebral discs, which absorb the impact of your movements. When its inner gel pushes through a weak spot on the outer layer, the disc has ruptured. This doesn’t usually happen overnight; first, you may experience a small protrusion around the disc before its gel begins to leak. This can cause pressure which can cause pain.

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More About Ruptured Disc

lumbar foraminotomy

When the pain is severe, you may feel it radiate from the lower back and shoot down behind both legs; this is known as sciatica. In many cases, these symptoms of pain will heal themselves within a month. However, if you experience reoccurring pain, especially for many months, you’ve entered chronic stage and may eventually require surgery. Your spine specialist will recommend surgery as a treatment option if he or she feels it is necessary.

The anterior cervical decompression procedure is one of the more common surgical options for those with chronic ruptured disc pain. In this surgery, the surgeon removes the disc material from the front of the neck, and then the leftover space is fused to maintain its structure. It is also possible to treat a rupture with a posterior laminectomy, a similar procedure but through the back of the neck instead of the front.

Regardless, treating a disc rupture is usually complicated thanks to the way symptoms and pain manifest in individuals; a regimen that one person finds relieving won’t necessarily be as effective for another person. Because of this, it’s a good idea to work with a spine specialist rather than a general practitioner to learn about effective solutions that can hopefully prevent the need for surgical intervention.

What are the symptoms?

A spine’s discs serve to cushion and support the bones during both movement and impact. As previously mentioned, each disc is surrounded by a formidable gel and a durable outer layer to help facilitate its purpose. As the body twists and compresses over a lifetime, the outer layer of these discs expand and compress as well to prevent the vertebrae from taking damage. Over time, the discs can tear and leak the gel into the canal. 

When the home of several nerve roots becomes flooded with the nucleus, there is a much higher risk of pinching or compressing the nerve roots. At this point, painful, obvious symptoms begin to occur. Severe lower back pain is one of the most common ruptured disc symptoms, but this can also manifest from muscle sprains. However, if you are experiencing pain in your lower back along with shooting pain down the legs, a ruptured disc seems much more likely. 

Symptoms strongly pointing towards sciatica are:

  • Tingling in the foot or in part of the leg
  • Weak legs
  • Sharp pain shooting down one or both legs and the buttocks

Those with ruptured discs may experience more severe sciatica-related pain when sitting, bending over, or sneezing while on the toilet–all movements that strain the sciatic nerve. 

 

 

 

How is are Ruptured Discs Diagnosed?

If you experience the symptoms of a ruptured disc as described above, then you’ll need to see the doctor for a proper diagnosis. Though you may think this part is as simple as a quick imaging scan, diagnosis is actually fairly involved; you’ll need to undergo a detailed interview as well as a few physical tests to eliminate other potential causes.

Potential Questions:

When you see the doctor about your lower back pain, you’ll likely be asked about when it started and whether or not an injury could have caused it. Other questions may include:

  • Type of pain: You may need to describe the pain in detail, including what aggravates or relieves it. 
  • Medical conditions: Lower back pain could be caused by other conditions, such as osteoporosis. 
  • Home/work life: If you’re regularly lifting heavy weights or sitting in strange positions, you’re at greater risk of pressuring your spinal discs. 
  • Family medical history: If a member of the family has ruptured a disc in the past, you are more likely to experience the same yourself. 
  • Personal medical history: Be honest about all previous injuries you’ve had.

Physical Exams:

After getting through the questions, next is the physical examination. This is not your ordinary checkup; you’ll need to bend and stretch to see if any of these movements trigger pain suggesting a rupture. The following examinations are typical for the doctor to try:

  • Neurological check: The doctor tests for numbness or weakness in the feet and legs, the presence of which would indicate a loss of sensation, which can indicate a ruptured disc. 
  • Motion tests: You may need to bend from side to side and lean forward and back. 
  • Leg raises: The straight leg raise is a very common stretch test in which you lay on your back and the doctor raises your leg slowly until you feel pain. If this happens at a 30 to 70 degree angle, there is likely herniation. If your unaffected leg also hurts at this point, you likely have an impinged nerve root.

If the ruptured disc pain is not severe and there are no signs of a serious problem, then you may not necessarily have to undergo imaging tests at this point. Sometimes, it is preferred to wait and see if the symptoms go away in the traditional six-week period. This is because imaging tests alone are not enough to diagnose the condition; the doctors must rule out other causes first to ensure they will give you the correct treatment. 

What are the causes of a Ruptured disc?

low back pain

Under normal conditions, the discs between the spine can absorb the forces of the spine whenever you lift something or twist and bend. The problem begins when the gelatinous material makes its way into the spinal canal, drying out and growing stiff before eventually flaking away. Here are some potential causes of this problem:

  • Age-related wear and tear
  • Too much pressure on a nearby nerve in the spine, causing nerves to become inflamed and painful.

How are Ruptured Discs treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Fusion/Stabilization

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of a Ruptured Disc

When your doctor feels it is necessary, then you will need to undergo imaging tests to help narrow down the likelihood of a disc rupture. Certain tests will rule out other conditions that could cause lower back and sciatic pain, such as an untreated fracture, an infection, or even a tumor. 

There are a few different kinds of imaging tests that can help narrow down the diagnosis:

  • Magnetic Resonance Imaging (MRI): This is the most accurate way to assess the lumbar area, which can reveal affected nerves and where any rupture has occurred. Generally, this scan is used when surgery is already planned as it can help narrow down where to make the repairs. 
  • Computed Tomography (CT): If, for some reason, you are not able to have an MRI, you will likely undergo a VT scan instead. 
  • X-Ray: This is usually done to make sure there isn’t a broken bone, infection, abnormality or tumor causing a problem with the spine. They are not otherwise used as a diagnosis tool for ruptures. 
  • CT Myelogram: Similar to the CT scan, this type of tomography scan combines x-rays with a contrast dye to help determine the location and size of a rupture, but the procedure is somewhat invasive, requiring an IV. 
  • Electromyography (EMG): This type of imaging can reveal the specific nerves affected by the pressure.

How Does Ruptured Disc Compare to Other Spine Conditions?

When the disc ruptures in the lower part of the spine, sciatic pain is much more likely. As you may have guessed, this nerve passes through the buttocks, legs, and all the way down to the feet, which is why these sites commonly feel numb or tingling.

A weakened disc is much more likely to rupture from normal activities you perform every day. However, due to the natural effect of aging on a disc, it is hard to pinpoint a rupture to any one event that could have caused it.

Studies also show up to 25 percent of chronic lower back pain is actually due to problems with the sacroliac joint, not the spine. This joint bears and transfers upper body to leg movement, and it too grows unstable over time due to aging or heavy physical activity. As the joint wears down, it can create a pain much like sciatica, appearing to be a ruptured disc. 

  • Collapsed Disc
  • Herniated Disc
  • Herniated Nucleus Pulposus (HNP)
  • Slipped Disc
  • Disc Extrusion
  • Disc Protrusion
  • Pinched Nerve
  • Compressed Nerve

Unfortunately, most spinal specialists do not pay much mind to this joint because they are not trained to look for it in their residency, and patients rarely know to ask about it. Then the imaging tests reveal that the spinal discs are narrowing, but they cannot tell whether the discs themselves are causing the pain, which further muddies the correct diagnosis for the person in the most pain. 

What does this all result in? People often go through the motions of treatment, starting from self-care to physical therapy and chiropractic treatment all the way down to laser operations and surgery, and none of the actions attack the real cause of their problems. 

If you have dealt with severe lower back pain for quite some time, be sure to tell your doctor you’d like to have your sacroliac joint examined along with the check for a ruptured disc. It’s also a good idea to find a specialist who specifically mentions having experience dealing with this joint in the first place; this is where doing your research on the Internet comes in handy.

Analogy: Blow-Out vs Flat Tire

A bulging disc is like a flat tire, a ruptured disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a bulging disc (flat tire) can progress to become a prolapsed disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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