The bones (vertebrae) that form the spine within the back are cushioned by discs. These discs are round, like small pillows, with a troublesome , outer layer (annulus) that surrounds the nucleus. Located between each of the vertebra within the vertebral column , discs act as shock absorbers for the spinal bones.
A ruptured intervertebral disc (also called bulged, slipped or ruptured) may be a fragment of the disc nucleus that’s pushed out of the annulus, into the vertebral canal through a tear or rupture within the annulus. Discs that become herniated usually are in an early stage of degeneration. The vertebral canal has limited space, which is insufficient for the nerves spinalis and therefore the displaced ruptured intervertebral disc fragment. thanks to this displacement, the disc presses on spinal nerves, often producing pain, which can be severe.
Herniated discs can occur in any a part of the spine. Herniated discs are more common within the lower back (lumbar spine), but also occur within the neck (cervical spine). the world during which pain is experienced depends on what a part of the spine is affected.
A single excessive strain or injury may cause a ruptured intervertebral disc . However, disc material degenerates naturally together ages, and therefore the ligaments that hold it in situ begin to weaken. As this degeneration progresses, a comparatively minor strain or twisting movement can cause a disc to rupture.
Certain individuals could also be more susceptible to disc problems and, as a result, may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families with several members affected.
Symptoms vary greatly, counting on the position of the ruptured intervertebral disc and therefore the size of the herniation. If the ruptured intervertebral disc isn’t pressing on a nerve, the patient may experience a coffee backache or no pain in the least . If it’s pressing on a nerve, there could also be pain, numbness or weakness within the area of the body to which the nerve travels. Typically, a ruptured intervertebral disc is preceded by an episode of low back pain or an extended history of intermittent episodes of low back pain.
Lumbar spine (lower back): Sciatica/Radiculopathy frequently results from a ruptured intervertebral disc within the lower back. Pressure on one or several nerves that contribute to the nerves ischiadicus can cause pain, burning, tingling and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually, one side (left or right) is affected. This pain often is described as sharp and electric shock-like. it’s going to be more severe with standing, walking or sitting. Straightening the leg on the affected side can often make the pain worse. along side leg pain, one may experience low back pain; however, for acute sciatica the pain within the leg is usually worse than the pain within the low back.
Cervical spine (neck): Cervical radiculopathy is that the symptoms of nervous disorder within the neck, which can include dull or sharp pain within the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers or numbness or tingling within the shoulder or arm. The pain may increase with certain positions or movements of the neck.
Testing & Diagnosis
Testing modalities are listed below. the foremost common imaging for this condition is MRI. Plain x-rays of the affected region are often added to finish the evaluation of the vertebra. Please note, a disc herniation can’t be seen on plain x-rays. CT scan and myelogram were more commonly used before MRI, but now are infrequently ordered because the initial diagnostic imaging, unless special circumstances exist that warrant their use. An electromyogram is infrequently used.
X-ray: Application of radiation to supply a movie or picture of a neighborhood of the body can show the structure of the vertebrae and therefore the outline of the joints. X-rays of the spine are obtained to look for other potential causes of pain, i.e. tumors, infections, fractures, etc.
Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads X-rays; can show the form and size of the vertebral canal , its contents and therefore the structures around it.
Magnetic resonance imaging (MRI): A diagnostic assay that produces 3D images of body structures using powerful magnets and computer technology; can show the medulla spinalis , nerve roots and surrounding areas also as enlargement, degeneration and tumors.
Myelogram: An X-ray of the vertebral canal following injection of a contrast medium into the encompassing spinal fluid spaces; can show pressure on the medulla spinalis or nerves thanks to herniated discs, bone spurs or tumors.
Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue. this may indicate whether there’s ongoing nerve damage, if the nerves are during a state of healing from a past injury or whether there’s another site of nervous disorder . This test is infrequently ordered.
The initial treatment for a ruptured intervertebral disc is typically conservative and nonsurgical. A doctor may advise the patient to take care of a coffee , painless activity level for a couple of days to many weeks. This helps the nervus spinalis inflammation to decrease. Bedrest isn’t recommended.
A ruptured intervertebral disc is usually treated with nonsteroidal anti-inflammatory drug medication, if the pain is merely mild to moderate. An epidural steroid injection could also be performed utilizing a spinal needle under X-ray guidance to direct the medication to the precise level of the disc herniation.
The doctor may recommend physiotherapy . The therapist will perform an in-depth evaluation, which, combined with the doctor’s diagnosis, dictates a treatment specifically designed for patients with herniated discs. Therapy may include pelvic traction, gentle massage, ice and warmth therapy, ultrasound, electrical muscle stimulation and stretching exercises. Pain medication and muscle relaxants can also be beneficial in conjunction with physiotherapy .
A doctor may recommend surgery if conservative treatment options, like physiotherapy and medications, don’t reduce or end the pain altogether. Doctors discuss surgical options with patients to work out the right procedure. like any surgery, a patient’s age, overall health and other issues are taken into consideration.
The benefits of surgery should be weighed carefully against its risks. Although an outsized percentage of patients with herniated discs report significant pain relief after surgery, there’s no guarantee that surgery will help.
A patient could also be considered a candidate for spinal surgery if:
Radicular pain limits normal activity or impairs quality of life
Progressive neurological deficits develop, like leg weakness and/or numbness
Loss of normal bowel and bladder functions
Difficulty standing or walking
Medication and physiotherapy are ineffective
The patient is in reasonably healthiness
Lumbar Spine Surgery
Lumbar laminotomy may be a procedure often utilized to alleviate leg pain and sciatica caused by a ruptured intervertebral disc . it’s performed through alittle incision down the middle of the rear over the world of the ruptured intervertebral disc . During this procedure, some of the lamina could also be removed. Once the incision is formed through the skin, the muscles are moved to the side in order that the surgeon can see the rear of the vertebrae. alittle opening is formed between the 2 vertebrae to realize access to the ruptured intervertebral disc . After the disc is removed through a discectomy, the spine may have to be stabilized. fusion often is performed in conjunction with a laminotomy. in additional involved cases, a laminectomy could also be performed.
In artificial disc surgery, an incision is formed through the abdomen, and therefore the affected disc is removed and replaced. Only alittle percentage of patients are candidates for artificial disc surgery. The patient must have disc degeneration in just one disc, between L4 and L5, or L5 and S1 (the first sacral vertebra). The patient must have undergone a minimum of six months of treatment, like physiotherapy , pain medication or wearing a brace , without showing improvement. The patient must be in overall healthiness with no signs of infection, osteoporosis or arthritis. If there’s degeneration affecting quite one disc or significant leg pain, the patient isn’t a candidate for this surgery.
Cervical Spine Surgery
The medical decision to perform the operation from the front of the neck (anterior) or the rear of the neck (posterior) is influenced by the precise location of the ruptured intervertebral disc , also because the experience and preference of the surgeon. some of the lamina could also be removed through a laminotomy, followed by removal of the disc herniation for the posterior approach. Patients, who are a candidate for posterior surgery, frequently don’t need surgical fusion. For anterior surgery, after the disc is removed, the spine must be stabilized. this is often accomplished employing a cervical plate, interbody device and screws (instrumentation). during a select group of candidates, artificial cervical disc is an option vs. fusion.
The doctor will give specific instructions after surgery and typically prescribe pain medication. He or she is going to help determine when the patient can resume normal activities, like returning to figure , driving and exercising. Some patients may enjoy supervised rehabilitation or physiotherapy after surgery. Discomfort is predicted during a gradual return to normal activity, but pain may be a alarm that the patient might got to hamper .