Ruptured Disk (Herniated or Prolapsed Vertebral Disk)

The human spine has 33 vertebrae separated by disks made of cartilage and fibrous tissue that act as cushions. These disks have a tough outer portion, the annuius fibrosis, which holds the pulpy inner nucleus in place. If the annuius weakens or becomes stretched, the nucleus bulges out, resulting in a so-called slipped disk. Depending on the extent of the abnormality, more accurate medical terms are a bulging, herniated, extruded, ruptured, or prolapsed disk.

Not all protruding disks produce symptoms, but if the herniated portion presses on a nerve root, it can cause mild to severe back pain, sciatica (a pain shooting down one leg), or arm pain. The pain often subsides during rest, only to return as soon as the patient moves around. There may also be numbness, tingling, or even paralysis and loss of bladder control.

Diagnostic Studies and Procedures

A doctor will observe the patients posture while standing and walking, test muscle strength in the arms and legs, and stimulate certain nerves to detect any loss of sensation.

X-rays are usually made, as well as a CT scan or MRI. Myelography may also be used to identify more precisely whether a disk is bulging or ruptured. In this procedure, a dye is injected into the spinal column while the patient lies on a special table that can be tilted as a series of X-rays are taken.

Medical Treatments

In most cases, nonsurgical treatment is tried first. This usually consists of a few days of bed rest, followed by a gradual return to normal activities. Aspirin or a stronger non-steroidal anti-inflammatory drug (NSAID) may be prescribed for pain and inflammation. If this fails to provide adequate relief, a short course of a narcotic painkiller, such as meperidine (Demerol) or propoxyphene (Darvon), may be justified. In some cases, diazepam (Valium) or another drug that relaxes muscles is prescribed to stop the spasms that often contribute to back pain. Hydrocortisone and other steroid drugs are occasionally used for a short period to relieve acute pain and inflammation. Traction may also be employed to relieve pain and, depending on the disk's location, a neck collar or back brace may be recommended.

Surgery is considered if symptoms persist after four to six weeks of rest and drug therapy. It may be done sooner if there is numbness or loss of bowel and bladder function.

The operation usually involves removing part or all of the ruptured disk and possibly some of the lamina, the bone that makes up the back wall of the spine. Increasingly, disks are being removed by microsurgery, which requires only small puncture openings. There is very little bleeding and the patient usually can go home within a day or two.

Alternative Therapies

A word of caution: Alternative therapies should be tried only after a doctor has established the diagnosis.

Acupuncture. This is now a widely accepted treatment for back pain that is caused by muscle spasms.

Alexander Technique. Correcting posture and learning more effective ways to carry out day-to-day activities can be useful in reducing back pain as well as preventing its recurrence.

Chiropractic. Practitioners use manipulation to treat many neck and back problems. Caution is needed, however, some manipulative methods can worsen a ruptured disk; it is advisable to determine beforehand whether or not chiropractic treatments are likely to exacerbate the problem.

Massage. This approach is especially useful for relieving muscle spasms. Shiatsu, rolling, and other vigorous types of massage should be approached with caution if a disk is ruptured.

Osteopathy. In addition to conventional treatment methods and surgery, osteopaths also use manipulative techniques to relieve muscle tension and improve body function.

Physical Therapy. Physical therapists often provide an alternative to surgery by supervising rehabilitative exercise, and using pain-relieving techniques, including application of heat or cold, massage, and electrical stimulation.

Self-Treatment

Although a ruptured disk needs medical care, self-care may prevent its occurrence. A doctor or physical therapist can recommend exercises to help strengthen the abdominal muscles and support the back. A Scandinavian study also found that regular aerobic exercises may reduce the incidence of ruptured disks.

Other Causes of Back Pain

Various types of arthritis or spondylosis can cause back pain, as can osteoporosis (the thinning of bones), and scoliosis, an abnormal curvature of the spine. Cancer that has originated in the spine or metastasized to the bones is still another possible source of back pain.