What Happens When a Disc Ruptures?
When the outer lining (annulus) of a disc “tears,” its center (the nucleus) may rupture and press a spinal nerve(s) against the bony surface of a vertebra (Fig. 5). This condition is often referred to as a ruptured disc. You could think of it as having a tube of toothpaste with a crack in it. Exert pressure on the cracked tube (disc annulus), and toothpaste (disc nucleus) flows out the crack. Even pressure from everyday activities can push the disc’s nucleus through the ruptured annulus and pinch a spinal nerve root(s).
What Causes a Disc to Rupture?
As we’ve discussed, your lumbar spine supports the weight of your entire upper body and is under stress every day. Simple “wear and tear” or the effects of aging can contribute to a disc rupture. In some cases, the rupture happens during the course of normal, everyday activities. In other cases, it occurs as the result of a specific injury. Usually there is no way to “prevent” it from occurring, however, you can reduce your risk by staying in good physical condition and by using proper lifting techniques.
What are the Symptoms of a Ruptured Disc?
When a lumbar spinal nerve is pinched, you may experience pain in your lower back, pain or numbness in your leg(s), weakness in your legs or feet, or numbness in one or both of your feet. The pain can come from the pressure on the nerve, the swelling within the nerve (caused by the pressure) or injury to the nerve itself. Taking pain medication or drugs which reduce the swelling may provide relief, but healing may not occur as long as the nerve itself remains pinched. It’s similar to having your finger caught in a door. An aspirin may help to ease the pain, but healing won’t begin until the door is opened and your finger is no longer being pinched.
How is a Ruptured Lumbar Disc Diagnosed?
The diagnosis of a ruptured lumbar disc is based on:
- Your history of back and/or leg pain
- A physical examination of your back and legs
- Diagnostic tests, which may include spine x-rays, an MRI, a CAT scan or a myelogram. (Each of these examinations has a specific purpose.)
There are a number of treatment options for a ruptured lumbar disc, each accompanied by its own set of risks and benefits. The four basic approaches are as follows:
- Taking Time: For some patients, all that is required in order to heal and recover is time.
- Taking Medication: For others, medication may reduce the inflammation or ease the pain in the affected area and thereby provide relief from their symptoms.
- Using Physical Therapy: For some, physical measures such as physical therapy (or gentle exercise) may provide relief and aid in the recovery from a ruptured disc.
- Having Surgery: For those patients whose ruptured disc is causing a “pinched” nerve, lumbar microdiscectomy often is the recommended treatment.
When Lumbar Microdiscectomy is NOT an Option
The severity of your symptoms (pain, weakness, lack of mobility) and your general health and physical condition will play an important part in determining when surgery is not an option for you. In general, surgery is not an option when:
- Your back and leg pain is not caused by a ruptured disc
- You do not have leg symptoms
- There is a medical reason which prevents you from having surgery
- Medication which reduces swelling or relieves pain would provide you with adequate relief
- Physical measures would improve your condition.
…and Their Risks and Benefits
When Lumbar Microdiscectomy IS an Option
Lumbar microdiscectomy is usually recommended only when specific conditions are met. In general, surgery is recommended when a ruptured disc is pinching a spinal nerve root(s) and you have:
- Leg pain which limits your normal daily activities
- Weakness in your leg(s) or feet
- Numbness in your extremities
- Impaired bowel and/or bladder function
The Risks of Having Surgery
Some of the more common risks of having any surgery include excessive bleeding, infection, or a negative reaction to anesthesia. Certain unforeseen circumstances could even lead to death. Clinical experience and scientific calculation indicate that these risks are low, but surgery is still a human effort. You should feel free to ask any questions you have about your specific risk factors.
Since microdiscectomy involves surgery in and around the spine, further nerve damage is a possibility. In some cases, the nerve is already so damaged that the surgical procedure required to simply reach the nerve could be the “straw that breaks the camel’s back.” The end result could be numbness, paralysis or a loss of bowel and bladder control. (However, deciding not to have surgery may have exactly the same consequences. Your decision should be based on a weighing of the risks of having surgery versus the risks of not having surgery.)
The Benefits of Having Surgery
You can think of surgery as the first step in the healing and recovery process. It can help relieve pressure on your spinal nerve or nerves and, thereby, help relieve your pain. It also may help you begin the process of regaining some of the lost mobility in your extremities.
Microdiscectomy and its Specific Benefits
Lumbar microdiscectomy is an operation on the lumbar spine performed using a surgical microscope and microsurgical techniques (Fig. 6). A microdiscectomy requires only a very small incision and will remove only that portion of your ruptured disc which is “pinching” one or more spinal nerve roots. The recovery time for this particular surgery is usually much less than is required for traditional lumbar surgery.
Your Chances for Success
Your level of healing will be determined by your age, your general health and the severity of the damage to your spinal nerve, as well as your attitude and your willingness to work at recovery.
Making Your Decision
When you consider your options, keep in mind the impact your condition has on your way of life and carefully weigh the risks and benefits of having surgery against the risks and benefits of not having surgery. The decision is yours!
If You Decide to Have Surgery…
Approach your surgery with a positive mental attitude and with full confidence that you have made the right decision. While the surgeon concentrates on finding and removing the cause of your pinched nerve, you must concentrate on the recovery process. Cooperate fully with your surgeon and focus on the improvements you will make in the future-not on the problems of the past.