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

Also known as a herniated or ruptured disc, a torn disc occurs when disc degeneration leads to a vertebral disc becomes compromised, or when the natural process of aging causes trauma over the years. In both cases, a tear develops on the outermost layer of the disc, which causes a small herniation of said disc.

The tear occurs when a crack appears on the outer wall of the spinal disc, and the nucleus may or may not be leaking from the inside. Sometimes, the interior starts to leak out of the disc, which leads to a total herniation of the disc. A single tear is usually due to stress or injury, and most commonly occur in the most mobile parts of the spine: the lower back and the neck. 

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More About Torn Disc

lumbar foraminotomy

Like with any of the other ligaments in the spine, it is possible to injure the discs. For example, the annulus might rupture or tear at any point of the surface. If this occurs and none of the nucleus has leaked, it is known as an annular tear. The outermost third of the disc are inundated with pain nerves, so this kind of tear usually involves severe pain. Over time, scar tissue will heal over the tear, but the disc remains at a higher risk for future tears and worse. Studies have shown that developing torn discs could lead to degeneration of the facet joints, endplates, or spinal discs. 

An intervertebral disc refers to the tough ligament between the vertebrae in the spine, connecting each bone to the other. These discs serve as vertebral cushions that absorb the shock of movement. The exterior contains the annulus fibrosus, a ring of fibers, and serves to protect the gelatinous interior, high in water content, called the nucleus pulosus.

Inside the fibers is the nucleus, and the region serve to deliver even pressure across the whole disc. The disc’s center is well-hydrated, which is what allows it to absorb the shock of every day movement. This interior takes the impact’s energy and prevents the vertebrae from touching one another. 

The majority of torn discs are simply caused by aging. Because most of the body weight rests on the neck and back, these two regions will wear down over the years. In fact, most people begin to experience intervertebral disc degeneration to some degree by the age of 30. 

Advanced degeneration can cause torn discs with too much repetitive motion because the disc exterior is already vulnerable. Injury can also cause a disc to tear, especially with high impact sports like football and gymnastics, or others who also have very stressful, demanding careers. 

What Are the Symptoms?

Between the nerves on the outside of the disc and impingement of other nerves, pain is likely with this condition. If you have ever experienced the symptoms of a torn disc, then you are well aware of the pain involved. Other symptoms include:

  • Numbness or tingling in the leg or foot (if disc is in the lumbar region)
  • Numbness or tingling in the arm or hand (if disc is in the cervical region)
  • Loss of coordination
  • Muscle Spasms
  • Weakness in the muscles
  • Sciatica-like symptoms

How is a Torn Disc Diagnosed?

To diagnose both a torn disc and degenerative disc disease, there are several methods to confirm the cause of your pain, as well as discover how the anatomy of the spine is doing.

Interview

In all cases, the first thing that will happen on the way to developing a torn disc treatment plan is to review your current symptoms and learn about your medical history. The symptom review should include:

  • A description of how the pain feels, like dull, achy, sharp, burning, stabbing, or searing 
  • Where the pain is located, whether it is confined, or whether it extends to an extremity 
  • If there are treatments, positions, or exercises that make the pain worse or better

By gathering a full medical history, your doctor will be able to rule out any other conditions that could mimic a torn disc by manifesting the same symptoms. A complete history may include past diagnoses, health problems that keep coming back, and how effective any past treatments were, as well as exercise habits, sleep health, and diet. 

Physical Examination:

After the interview, the doctor will need to conduct a physical exam to further narrow down the cause:

  • Palpating: The doctor will start by simply feeling the affected region to see if there are any obvious abnormalities. For instance, there could be pain when pushing against a disc, indicated it is damaged. 
  • Reflex test: Irritation of nerve roots can dampen your leg or arm reflexes. The reflex test refers to using a reflex hammer to tap certain joints to prompt a reaction. If there is an insufficient reaction, this is a sign of a pinched nerve root. 
  • Movement tests: The doctor will assess your range of motion by bending the torso to the side, forward, and backward. If there’s pain when raising a straight leg in front of your body, this is a symptom of a torn disc or herniated disc in the lower back region. 
  • Muscle strength: This neurological exam concludes the list, determining if a herniated disc has compressed a nerve root by checking the strength of affected muscles. Specifically, you will need to hold a leg or arm out to the side to test for atrophy or tremors.

What are the Causes of a Torn Disc?

low back pain

The most common cause of a torn disc is the natural process of aging. As you get older, the outside of the spinal discs become more rigid and prone to flaking as the water content dries out from inside. This degeneration restricts the cushioning of the disc and keeps it from giving the necessary support every day movement requires. 

Typical positions like walking, standing, and sitting can all stress the disc, which can causes older, weaker discs to crack and tear. Torn discs can still appear in a younger patient, of course, if there is a sudden, excessively forceful impact, like from a sports injury or a car accident. 

Though aging is the most common cause, there are a few other factors that can play a part in developing a torn disc:

  • Smoking: Insufficient blood oxygen levels will deprive the discs in the spine of the nutrients it requires 
  • Overexertion: Playing high impact sports like gymnastics, football, and hockey can result in early spinal disc degeneration 
  • Excess weight: Likewise, too much body weight puts unneeded pressure on the spine, which can result in early degeneration

How are Torn 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

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

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 Torn Disc

If your doctor suspects a torn disc, he or she may order imaging tests alongside the physical exam:

  • X-ray: This won’t reveal a herniation, but the test rules out other sources of back pain. 
  • CT scan: This produces a more detailed x-ray thanks to images from various angles, combined on a computer. 
  • MRI: Radio waves and a magnetic field join forces to produce images of the internal structures of the body. 
  • Myelogram: This is similar to a CT scan, but with a dye injected into the back to reveal pressure on the spinal cord. 
  • Nerve tests: Nerve conduction studies like electromyograms can measure the movement of electrical impulses along the muscles.

 

How Does Torn Disc Compare to Other Spine Conditions?

Problems with the spinal disc tend to be misunderstood heavily for several reasons, not the least of which is the fact that the terms used tend to be used interchangeably, such as slipped disc, torn disc, degenerated disc, herniated disc, bulged disc, and so on. It certainly doesn’t help when medical professionals themselves don’t agree on everything regarding the spine and the causes of its problems. 

Though there are dozens of terms involved in diagnosing problems with the spinal discs, they all boils down to two categories of disc conditions. 

Degenerative Disc Disease 
If the disc itself is the source of the pain, then you will experience referred or axial pain. This can be simply due to aging, as the inner portion of the disc loses volume and causes the vertebrae to touch each other, causing pain. 

Herniated Disc 
If your damaged disc is causing pain in a nerve root, you will experience radicular pain. This occurs when the inner nucleus escapes its housing and pressures the nerve root.

No matter what the true diagnosis is, testing is generally the same as is treatment. Be sure to talk with your doctor to discuss your treatment options.

Analogy: A Baseball

Think of each of your spinal discs as a baseball. The casing of the baseball is strong enough to keep the insides of the baseball intact during normal situations. However, age, wear-and-tear, or one really good wallop could cause the outer casing to tear. The difference between a torn disc and a ripped baseball is annular tears usually begin from the inside.

Good Baseball

Flat Tire

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