BACK, RUPTURED DISK (Herniated Disk; Slipped Disk; Herniated Nucleus Pulposus) |
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General Information
DEFINITION--Sudden or gradual break in the supportive ligaments surrounding a spinal disk (a cushion separating bony spinal vertebrae).
BODY PARTS INVOLVEDDisks of the neck or lower spine are the most common sites, especially between the 4th and 5th lumbar vertebrae.
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SIGNS & SYMPTOMS
IN THE LOWER BACK:
Severe pain in the low back or in the back of one leg, buttock or foot (sciatica). Pain usually affects one side and worsens with movement, coughing, sneezing, lifting or straining.
Weakness, numbness or muscular wasting of the affected leg. IN THE NECK:
Pain in the neck, shoulder or down one arm. Pain worsens with movement.
Weakness, numbness or muscular wasting of the affected arm.
CAUSESWeakening and rupture of the disk material, creating pressure on nearby spinal nerves. Rupture of the disk is caused by sudden injury or chronic stress, such as from constant lifting or obesity.
RISK INCREASES WITH
Any sport in which movement causes downward or twisting pressure on the neck or spine. The most common include bowling, tennis, jogging, track, football, racquetball, weight-lifting or gymnastics.
Poor muscle conditioning and inadequate warm-up.
Family history of low-back pain or disk disorders. Genetic factors apparently play a poorly understood role in increasing risk.
Pre-existing spondylolisthesis.
HOW TO PREVENT
Practice proper posture when lifting.
Exercise regularly to maintain good muscle tone.
If previously injured, avoid any vigorous physical activity that requires twisting of the body under uncontrollable conditions.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Self-care after diagnosis.
Doctor's treatment. (WARNING: Violent chiropractic adjustments may be hazardous.)
Traction at home or in the hospital (sometimes).
Surgery to relieve nerve pressure if bed rest does not relieve symptoms and special studies confirm the diagnosis and location of a protruding, ruptured disk.
Injection of chymopapain enzymes into the disk (sometimes).
Rehabilitation to strengthen muscles.
Psychotherapy, counseling or biofeedback training to learn coping methods for enduring pain when pain persists despite treatment.
DIAGNOSTIC MEASURES
Your own observation symptoms.
Medical history and physical exam by a doctor.
X-rays of the neck or lower spine, including myelogram (See Glossary).
CAT scan (See Glossary).
POSSIBLE COMPLICATIONS
Loss of bladder and bowel function.
Paralysis of the arm (neck disk rupture) or leg (lower-back disk rupture).
Muscle wasting and weakness.
Decreased sexual function.
Surgical-wound infection if surgery is required.
PROBABLE OUTCOMESpontaneous recovery in many cases. Bed rest for at least 2 weeks should be tried before considering other therapy (unless complications occur). When necessary, surgery with or without spinal fusion may cure the problem.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Don't move any person with a neck or back injury unless his or her life is at risk. Don't twist the back, neck or head. Support the whole back and neck with splints of any sort.
Keep the person warm with blankets to decrease the possibility of shock.
Seek emergency medical help immediately.
CONTINUING CAREApply ice packs to the painful area during the first 72 hours and occasionally thereafter, if they provide relief. Alternately, try to relieve pain with a heat lamp, hot showers, hot baths, warm compresses or a heating pad.
MEDICATION
For minor discomfort, you may use non-prescription drugs such as aspirin or ibuprofen.
Your doctor may prescribe:
Pain relievers.
Muscle relaxants.
Non-steroidal anti-inflammatory drugs to reduce inflammation around the rupture.
Laxatives or stool softeners to prevent constipation.
ACTIVITYRest in bed at least 2 weeks during the acute phase. You may read or watch TV. Resume your normal activities when symptoms improve or after recovery from surgery. Resume athletic activities after clearance from your doctor.
REHABILITATIONSee section on rehabilitation exercises, depending on the area of injury. Begin rehabilitation after clearance from your doctor.
DIETNo special diet. Increase consumption of dietary fiber and drink at least 8 glasses of fluid a day to prevent constipation or fecal impaction due to decreased physical activity during treatment.
CALL YOUR DOCTOR IF
You have symptoms of a ruptured disk.
The following occurs during treatment:
Increased pain or weakness in the extremities.
Loss of bladder or bowel control.
New, unexplained symptoms. Drugs used in treatment may produce side effects.
After treatment, weakness, numbness or pain in the back, buttock, legs or arms returns.
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