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Ruptured Disc

INTRODUCTION

A ruptured disc is also referred to as a Herniated disc condition. The spinal column extends from the base of the skull to the pelvis. It is composed of thirty-three vertebrae. These vertebrae allow motion and render flexibility while the bones, ligaments and muscles provide stability. The spinal column is designed as such to enable the mobility for everyday activities. In between the individual vertebrae bodies are discs. It appears to be in a stack-like position with the vertebrae, where the discs serve as protection to minimize friction between the individual vertebrae.

The disc resembles a jelly donut form. It has a tough exterior (annulus fibrosus) with a soft gel in the middle (nucleus pulposus). Both are composed of water, collagen and proteoglycans but fluid content is much higher in the inner core. Due to a variety of reasons more commonly caused by the natural process of aging, these discs can degenerate. A rupture in the outer wall can develop thereby allowing the inner core to push out of its exterior. It can result to excruciating pain and symptoms if the displaced inner substance affects the spinal cord or inflame nearby nerves.

CAUSES

The most common cause of a ruptured disc is the natural process of aging. Overtime, the discs lose their elasticity or gradually degenerate. This is due to the loss of water content in the discs – making them brittle and less flexible. The normal everyday activities can eventually put enough pressure on the already deteriorating discs and cause the inner gel-like substance to push through a rupture or tear in the outer wall. Although the aging process is inevitable, there are other factors that can speed up the on-going deterioration. The following are possible causes that accelerate the development of a ruptured disc:

  • Spine Trauma

A forceful blow on the spine can lead to an injury that causes a ruptured disc. This kind of injury is common in high-impact sports such as football and gymnastics. It can also develop through repetitive motions in the spine such as twisting. This is common for activities or physically demanding jobs that may require repetitive motions.

  • Overweight

The spine is primarily responsible for supporting the body’s weight specifically in the abdominal region. The increased pounds causes the vertebrae to congest the spines in between and expose them to more pressure that can eventually lead to a tear in the outer wall which can allow the inner substance to flow through and cause painful symptoms.

  • Vibrations

Some jobs or certain activities will cause you to be exposed to constant vibrations such welders in a construction company. Engaging in these kinds of activities will increase the likelihood of developing ruptured disc.

  • Genetics

Disc degeneration conditions maybe apparent in a family history of a person. This also increases the chance for developing a ruptured disc in the spine.

  • Poor Lifting

Constantly lifting heavy objects can add pressure in the lower back causing it to accumulate small tears in the discs which eventually develops into a full rupture in the disc.

  • Smoking

Smoking can contribute to almost any degenerating spine condition. This is because it releases toxins in the body that can impede the nutrient supply to the discs in the spine and speed up the deterioration of cartilage.

SYMPTOMS

The symptoms of a ruptured disc will vary depending on the cause, position in the spine and severity of the condition. Symptoms will also vary if whether or not a nearby nerve has already been inflamed.  It commonly occurs in the cervical and lumbar spines because this is the part that exhibits more movement and support for the weight of the upper body. It’s also possible for the herniation not to show any symptoms at all. The following are examples of the many symptoms that occur due to a rupture in the disc:

  • Tingling sensations
  • Spasms
  • Muscle Weakness
  • Numbness
  • Weakness in chest and abdomen
  • Pain in the lower extremities
  • Cramping

RISKS

Old age is the primary risk factor for developing a ruptured disc. As we grow old, our bodies begin to deteriorate more, which includes our spine with all the discs and vertebrae. It is the main risk factor for developing a ruptured disc. The discs weaken with age and lose water content – becoming dehydrated, brittle and thin. Serving as shock absorbers while altogether losing their elasticity causes them to deteriorate.

With enough pressure from constant mobility it cause a rupture in the outer core. The inner gel-like substance pushes out of this tear in the outer wall which can eventually inflame or irritate nearby nerves that cause painful symptoms.

PREVENTION

A ruptured disc is a result of a tear in the outer lining (annulus fibrosus) of the discs that allow the inner substance (nucleus pulposus) to push through, not only irritating the outer wall but possibly also the surrounding spinal nerves. The discs act like shock-absorbers for the spine. They work together with the vertebrae to allow movement for the spine. They are in a stack-liked position where the discs lie in between the individual vertebrae. Due to the normal wear and tear – the constant pressure they are exposed to – the discs slowly degenerate overtime. The natural process of aging is the primary cause for developing a rupture in the outer wall of the disc. However, there are still many things one can do to either prevent or delay the development of the rupture. It all lies in a healthier lifestyle. They vary from life altering and seemingly small day-to-day decisions. The following steps are example of prevention methods:

  • Healthy Diet

Obesity can affect overall health including the spine. Aside from the primary cause – aging – an unhealthy weight can contribute to the development of a ruptured disc. Increased weight could mean increased compression in the discs of the spine that could lead to a tear in the exterior. Hence, maintaining a healthy diet will help one shed unnecessary pounds or keep it at a healthy number. This also ensures that essential nutrients are received by the body.

  • Maintaining an Active Lifestyle

Exercising is also one of the ways to avoid unnecessary pounds, thereby removing load from the weight-bearing support of the spine. Through certain stretches and exercises, one is able to strengthen core muscles that surround the spine and assist in supporting the upper body weight. It also helps in decompressing the spine which can decrease pressure from the discs.

  • Stop Smoking

Smoking releases toxins in the body that prevent the spine form receiving certain nutrients. As we age, the discs begin to degenerate and without the essential nutrients to keep it healthy, it could easily deteriorate more. This can lead to a tear in the outer wall of the discs. Hence, stopping smoking habits allows the normal circulation to flow, providing essential nutrients to the spine, thereby strengthening the discs to avoid ruptures in occurring. Depending on the gravity of the habit, there are various things one can do to quit smoking.

TREATMENT

A ruptured disc in the spine does not always cause painful symptoms. In fact, it is also considered to be asymptotic if the disc itself does not become irritated, or the inner substance does not irritate or inflame the spinal cord or the surrounding nerves. However, in cases where the ruptured disc causes certain symptoms, the treatments vary according to the location of the discs and the severity of the condition. Usually, a surgical treatment is considered as a last option. Other treatments that are not surgical in nature are considered to be conservative treatments. It is important to work with a physician to develop the best treatment for a patient since the wrong treatment can worsen the patient’s condition.

Conservative Treatment

  • Medication

A physician can prescribe a number of medications depending on a patient’s condition. It can include muscle relaxants, corticosteroids, opioids, hydrocodone and acetaminophen combinations, neuropathic pain medications and NSAID (anti-inflammatory drugs). NSAIDs are over-the-counter medicines such as ibuprofen, naproxen and aspirin, and is usually the medication prescribed to patients. They help reduce pain and other symptoms such as burning sensations, numbness and muscle weakness. NSAIDs will also either fully or partially remove the inflammation caused by the ruptured disc. However, patient’s whose medical history involves cardiovascular or gastrointestinal conditions will not be advised to take these medicines. Prescription steroids are stronger but serve the same purpose as NSAIDs. When these medications are ineffective, the physician can prescribe narcotics such as codeine or an oxycodone-acetaminophen combination, but are only administered for a period of time since they can be highly addictive. It is important to strictly follow the physician’s instructions of dosage and period of the medication.

  • Physical Therapy

The purpose of physical therapy is to relieve the patient from painful symptoms such as localized pain. It also aims to strengthen core muscles, and restore mobility and flexibility. It involves stretches and exercises that can be developed by a licensed physical therapist. The physical therapist can measure a patient’s current flexibility and limits of mobility in order to develop a treatment plan. The treatment plan can then include, strengthening and stretching exercises, learning proper body mechanics, soft tissue massage and aerobic activities. The physical therapist can also assist a patient in adjusting certain ergonomic factors at work or at home and if needed, help the patient lose weight to improve overall spine health.

It is composed of steroid and anesthetic medications. It is injected near the site of the compressed nerve that is causing painful symptoms. The injection acts as a temporary numbing agent and can help reduce inflammation. It can provide relief from symptoms for weeks and even months. The situation can vary for every patient.

  • Cold and Heat Therapy

Cold compress for twenty-minute intervals for several times a day can numb the area and reduce the inflammation r the swelling. The heating pads on the other hand can relieve muscle tension. However, this treatment can only provide short-term pain relief.

Surgical Treatment

Conservative treatments are usually the initial treatment for a ruptured disc unless immediate surgical operations are needed. If however after several conservative treatments, the symptoms still persist, then a surgical treatment is considered. Traditionally, the method of treatment is open spine surgery, but there are other minimally invasive surgeries that has less post-surgical pain and offer faster recovery.

  • Open spine surgery

This is the traditional surgery performed for ruptured discs in the spine. The surgery involves large incisions in the abdomen, neck or back. The incision is about six to eight inches that cuts through muscles and tissues that surround the spine to get to the infected area of the spinal column. Then, it involves the removal of the disc ether partially of fully. After which, the vertebrae are then fused together with stabilizing metal implants or bone grafts.

The recovery process can take several months. This operation however has a high risk for infection, excessive bleeding, affected muscles from incision and failed back surgery syndrome (FBSS). FBSS is the continuing occurrence or worsening of symptoms after the surgery, and may even require further surgery.

The upside of this procedure is that it has been tested for so many years. Professionals will have high level of expertise because of much greater experience in this kind of surgery. It’s much easier for doctors to have a clear visual on the structure of the spine. Also, only one large incision is needed so the surgeon can perform multiple operations on the spine. Hence, this procedure is much more suitable for those with multiple spine problems that need operation.

  • Minimally invasive surgery

This is an outpatient procedure. Unlike the open spine surgery it only makes a small incision in the neck or back. Then, multiple tubes are inserted carefully in order not to affect the muscle and tissues, but to push them softly aside. These tubes serve as tunnels through which microscopic surgical tools and camera are used to access the affected disc. Unlike the open back surgery, the surgeon’s visual of the spine structure comes from the camera. In order to relieve the affected nerve or the spinal cord, the inner substance that went out from the disc and sometimes bone fragments are vaporized. In severe cases, an artificial disc is implanted to replace the ruptured disc.

The minimally invasive surgery also has advantages when compared to the open spine surgery. It renders back muscles functional and unaffected post-surgery. Because of the smaller incision made it allows faster rehabilitation and recovery – less pain and chances for infection and blood loss are minimal. Overall, it is a lot more cost-friendly due to minimized hospitalization and the spinal procedure itself.

The downside for this kind of surgery is certainly first, it allows less proper visual for the surgeons conducting the operation. The surgery renders it difficult to perform multiple operations on the spine. Hence, when there are multiple complications the open spine surgery is performed. Because it is not the traditional method of surgery for treating ruptured disc conditions, plenty of surgeons are a lot less experienced in this field. Hence, the success of the operation will greatly depend on the doctor’s expertise in minimally-invasive surgeries.

RECOVERY

The period of recovery will be determined by several factors – location of the ruptured disc, severity of the condition, the kind of surgery performed and overall health. Some patients will recover faster while others might be slower. An athlete for example who has an active lifestyle may find it much easier to recover than someone with sedimentary lifestyle.

Recovery from an open spine surgery varies from several months to years, while recovery from a minimally-invasive surgery can last several weeks to a couple of months. For open spine surgeries, hospitalization can take up to several days because the patient will be under observation. Minimally-invasive procedure usually has no hospitalization involved, but the patient will be advised to rest at home – avoiding activities that can place pressure on the spine.

The key importance is to strictly follow the instructions post-surgery and the recovery plan given by the surgeon and the physician. It might involve a series of other treatments such as physical therapy to ensure successful recovery.

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