A ruptured disc, which affects the intervertebral discs in your spine, can cause moderate to severe pain in your back or neck. It may hurt to sit down or bend forward, or pain might be worse after standing for long periods of time. Intermittently, shooting pain might be felt through your upper or lower body. Regardless of your symptoms, a ruptured disc is exactly what it sounds like – an intervertebral disc that has essentially burst open. What causes a disc to rupture can vary, but out of all the degenerative disc conditions, it is the one most likely to cause pain.
Spinal Anatomy
Taking a closer look at the components that make up the spine is helpful when trying to better understand exactly what a ruptured disc is, how it occurs, and why it hurts.
Vertebrae – These are the bones that form the spine. The spine serves to support the body and is divided into several regions: cervical (neck), thoracic (mid-back), lumbar (lower back), sacral (sacrum, in the pelvic region), and coccygeal (tailbone). Most humans have 24 individual stacked vertebrae – seven cervical, 12 thoracic, and five lumbar – and eight to 10 fused vertebrae in the sacrum and coccyx. The individual vertebrae have cylindrical bases, or bodies, which serve as the platform for intervertebral discs. Projecting out of the back of the vertebral bodies are spinous and transverse processes, which is what you can feel when you run your finger down your back. Between the vertebral bodies and processes is a circular opening formed by the vertebral arch. When stacked together, these round openings in the middle of individual vertebrae form the spinal canal, the protective channel that the spinal cord runs through.
Intervertebral discs – Discs are pliable pads of cartilage sandwiched between two individual vertebrae. These discs are connected by tough, fibrous tissue (end plates) to the upper and lower bodies of adjacent vertebrae. Intervertebral discs provide shock absorption for the spine and help to facilitate movement.
Facet joints – Individual vertebrae are hinged together by pairs of facet joints at the posterior (back) of the spine. These joints are lined with cartilage and are encapsulated in synovial fluid, helping joints to glide smoothly against each other and allow the spine its wide range of motion.
Muscles, ligaments, and tendons – A number of flexible soft tissues form an additional support network for the spine, helping to keep the spine upright and providing the trunk with the ability to move.
Spinal cord and nerves – These neural structures serve as the communication highway between the brain and the rest of the body. The spinal cord begins at the base of the brain, travels through the spinal canal, and ends near the top of the lumbar spine. At this point, the spinal cord branches off into a bundle of nerves known as the cauda equina. From the neck down, nerve roots branch off the spinal cord and travel through foramina, or the small canals on the sides of stacked vertebrae. These nerve roots become spinal nerves, which then travel into other parts of the body.
Next it’s important to take a closer look at the specific makeup of intervertebral discs, since this helps in visualizing how and why a ruptured disc occurs. As mentioned previously, discs are sandwiched between individual vertebrae in the spine. Each disc has an outer wall (annulus fibrosus) made of tough, fibrous cartilage, and a gelatinous inner core (nucleus pulposus).
Annulus fibrosus – A disc’s outer wall is made up of type I collagen, the most abundant type of collagen in the body. The collagen fibers of the annulus fibrosus form tough bands of tissue (lamellae) that are arranged in concentric circles around the inner core of the disc. The fibers of each lamella are arranged in 30-degree angles in relation to the base of a disc. This pattern alternates diagonally in successive rings, giving intervertebral discs the unique capability of tensing and relaxing in different areas according to the spinal movements being performed. Additionally, the outer one-third of each disc’s annular wall is innervated with tiny nerve fibers.
Nucleus pulposus – A disc’s inner core is a gel-like matrix of water-attracting proteoglycan protein molecules and type II collagen fibers. The nucleus pulposus is also made up of nearly 80 percent water. This matrix not only provides a disc with its shock absorbing properties, but is also responsible for the absorption of nutrients into, and the expulsion of toxins out of, a disc, via the blood supply of vertebral end plates. Discs themselves are avascular, which means they do not have a direct blood supply.
A disc with a healthy annulus fibrosus and nucleus pulposus becomes susceptible to certain damage as we grow older. This usually begins with dehydration. Before dehydration, microtraumas, or small injuries, can affect the disc. The human spine is exposed to many bumps, bruises, falls, and jolts over time. These seemingly inconsequential events can eventually lead to the formation of tiny annular fissures or tears. Scar tissue can form around fissures, but new fissures may develop. The tearing and scarring cycle can potentially damage a disc’s nerve fibers, as well as hinder the highly important process of nutrient absorption and waste removal from the disc. These two events can both contribute to the dehydration of a disc, which may eventually threaten the structural integrity of the annulus fibrosus. A weakened disc wall could lead to a disc’s eventual rupture.
Understanding Your Ruptured Disc
You’ve likely heard many terms relating to a ruptured disc before, including “slipped,” “herniated,” “bulging,” “prolapsed,” and “extruded.” The terms are often confusing and hard to define, especially since there are usage inconsistencies among orthopedists, neurologists, chiropractors, and other spine specialists. One doctor may say you have a ruptured disc, while another may diagnose you with a herniated disc. In the most general sense, these terms all define a disc that has changed shape and expanded past its normal boundary, which is usually defined as the edges of vertebral bodies. Expansion can occur because a dehydrating and deteriorating disc is still subject to the normal forces of compression placed on the spine. As a result, a weakened annulus fibrosus may not be strong enough to withstand the increased pressure placed on the nucleus pulposus, causing the outer wall to tear, bulge, or rupture.
A ruptured disc is a type of herniated disc, defined by a fairly specific course of events; and is considered one of the more severe consequences of a deteriorating disc. To understand this, it can be helpful to take a brief look at and compare some of the other types of disc damage that can occur.
Bulging disc – Bulging discs are the most commonly diagnosed type of disc degeneration and are characterized by a circumferential expansion of disc material that is contained within the annular wall. Expansion can involve 50 to 100 percent of a disc’s circumference. Think of a bulging disc like a hamburger that is too large for its bun. In the majority of cases, a bulging disc remains asymptomatic for affected individuals.
Protruding disc – Another result of disc degeneration is a protruding disc, which is a type of herniation characterized by the localized protruding of disc material contained by the annular wall. Herniation of the interior fibers of the disc wall can occur when enough force is placed on a disc to cause a specific portion of fibers to tear apart. The pressurized nucleus pulposus can project into the damaged area of the inner annulus fibrosus and create a pocket, causing that specific area of the disc wall to bulge outward. A protruding disc may or may not cause an affected individual pain.
Ruptured disc – Finally, the annulus fibrosus of a protruding disc may eventually develop deeper fissures and tears as it continues to be subjected to pressure from the inside, placing the disc at a higher risk for rupturing. A ruptured, or extruded, disc is characterized by a complete tearing open of the annular wall and the release of inner disc material into the spinal column. This type of disc damage is almost always painful.
A ruptured disc can pose several problems for an individual with the condition. First, the open tear in the disc’s annular wall may damage the nerves that innervate the disc’s outer portion. This may cause discogenic pain, which is pain that originates in the disc itself. Second, the nucleus pulposus of a ruptured disc, no longer contained by the lamellae of the outer wall, can ooze from the tear, which may lead to two situations: The inner core’s inflammation-inducing proteins may further irritate the damaged annular fibers and cause additional inflammatory pain, and the released nucleus pulposus may come into contact with the spinal cord or a nerve root. Nerve compression can cause significant neurological symptoms.
Causes and Risk Factors
As discussed earlier, the dehydration of a disc over time can contribute to the formation of a ruptured disc, so it stands to reason that the act of growing older plays a role in degenerative spine conditions. However, for most people with a ruptured disc, the condition arises as a result of several combined factors.
In addition to age-related degeneration, a ruptured disc can also be caused by:
Trauma – Microtraumas can certainly contribute to the rupturing of a disc, but so can other forms of trauma. Injuries sustained from falls, car accidents, and contact sports can place sudden, extreme forces on the intervertebral discs and spine as a whole, increasing the chances of a disc rupture.
Genetics – Individuals whose direct family members have had degenerative disc issues may be more likely to develop a ruptured disc. Geneticists have even identified mutations to certain collagen genes (COL9A2 and COL9A3) that may increase an individual’s risk factor for disc rupture.
Excess weight – Since the spine supports the body as a whole, it stands to reason that added weight can affect its ability to do so. Weight gain, particularly in the abdominal area, can place undue stress on the discs, facet joints, muscles, and ligaments. Each component is forced to overcompensate in order to maintain a supportive role, but this can lead to accelerated spinal degeneration. Additionally, overweight individuals are more at risk for developing a ruptured disc after an awkward twisting or turning motion.
Repetitive stress – Similar to excess weight, the added pressure placed on the spine during occupational and recreational activities can contribute to the formation of a ruptured disc. For example, the mere act of sitting places three times as much force on the spine as when standing. Sitting at an office desk or driving all day can take its toll on all of the spinal components. Repetitive movements such as bending down to lift boxes or twisting the upper body to throw a football can also accelerate degenerative changes in the spine.
Lifestyle choices – Certain lifestyle choices and habits may also indirectly cause a disc to rupture. The spine and its components are susceptible to damage, weakening, and stress caused by poor posture, inactivity, an unhealthy diet, and excessive alcohol and tobacco use.
Symptoms of a Ruptured Disc
A ruptured disc is one of the degenerative disc conditions that is almost always painful. Pain usually stems from inflamed or damaged nerves. As mentioned before, a ruptured disc can be painful when leaking nucleus pulposus comes in contact with, and inflames, damaged nerve fibers in the annulus fibrosus. This alone may translate to an aching back or neck pain for an affected individual. Also, neurological pain that affects the extremities can arise if the expelled inner core disc material compresses the spinal cord or a nerve root.
A ruptured disc can occur at any level of the spine – in the cervical, thoracic, or lumbar regions. However, the condition is most commonly diagnosed in the lower back and neck, respectively, due to their high mobility and weight-bearing responsibilities. Symptoms will usually arise based on the location of the disc and whether the spinal cord and/or nerve roots are compressed.
In general, a cervical ruptured disc could cause one or more of the following symptoms:
Discogenic pain that translates as neck pain
Radiating pain in the shoulder, arm, hand, and fingers on one side of the body
Muscle weakness and spasticity
Numbness and tingling in one arm and hand
Weakness, difficulty walking, or even paralysis from the neck down, particularly if severe spinal cord compression has occurred
One or more of the following symptoms could arise with a lumbar ruptured disc:
Discogenic pain that translates as lower back pain
Radiating pain on one side of the body that affects the lower back, buttocks, hips, legs, and feet; also known as sciatica
Muscle spasms and weakness in the lower back and legs
Tingling and numbness in the legs and feet
Gait changes or lower body paralysis if severe compression of the cauda equina has occurred (this could pose an emergency situation that requires immediate medical attention)
If you’ve been diagnosed with a ruptured disc and are in pain, it’s important to remember that you’re not alone. Almost everyone will experience degenerative changes in the spine, and many people will develop a ruptured disc.
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