What should I do about a ruptured disc?

The term “ruptured disc” is a catch-all, which encompasses a variety of related conditions affecting the structural integrity of the intervertebral disc, which is the cushiony material between the vertebrae, or back bones. The disc is a complex structure containing a gelatinous inner portion, called the nucleus pulposis; and a tough and fibrous outer portion, called the annulus fibrosis.

In many ways, the disc is similar both in structure and function to a modern radial tire. The nucleus acts in much the same way as does the air in the tire, to dampen and absorb the forces applied to it. And the annulus also contains many layers of fibers, like the radial plies of a tire, to contain the nucleus and distribute the forces.

When the disc has been injured, there may be internal derangement of the disc architecture; there may be radial tears through the annulus, or delamination of the annular fibers. With further damage, nuclear material may protrude through these annular tears, resulting in disc protrusion, which may be contained, extruded, or sequestered (think of toothpaste being progressively squeezed out of the tube).

Each of these different types of disc protrusion has implications for treatment, and different types of intervention, or surgery, may be appropriate, depending upon the exact nature of the damage to the disc, and the particular symptoms which you have been experiencing. In many instances, effective relief of symptoms may be accomplished by a period of relative rest, or avoidance of provocative activities. Prolonged bed rest is, however, not generally beneficial. Physical therapy and medication may be helpful in reducing inflammation and easing muscle spasm.

However, protruding disc material may be toxic to the nerves, causing pain, or numbness and tingling. If the disc actually presses on the nerve roots – a so-called “pinched nerve” – the nerve may be damaged, and there may be symptoms of weakness, or even disturbances of bowel and bladder function.

A careful clinical examination is required, and appropriate tests, such as an MRI scan, should be performed, to clearly delineate the precise nature of the “ruptured disc”. You should discuss this with your doctor, so that you have a thorough understanding of the exact nature of your condition, and the treatment options available to you.

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