The "Ruptured" Herniated Disc

As can be seen in the above illustration, a ruptured disc is a herniated disc which has broken through it's annulus.

Clinical presentation:
Frequently patients will initially present with back pain/spasm . As the injured disc begins to tear and/or bulge, the pain will begin to travel into the buttock and leg. This pain in the leg is referred to as Sciatica. When the disc ruptures through its annulus, the back pain often subsides significantly. This can be compared to an abscess or boil, which when popped, feels much better. However, now the nucleus of the disk often compresses an adjacent nerve, resulting in more leg pain, despite improved back pain. This latter phenomena is almost diagnostic of a ruptured disc.

What happens next?
Now if the patient has a large spinal canal, there may be plenty of room for the spinal nerves to pass around the ruptured disc. Thus, after the initial few days of back and leg pain, the patient begins to feel significantly better. As long as there is no compression of neural structures, then surgery is not recommended! Another important criterion of the ruptured disc is the age of the patient, and more specifically, the degree of disc degeneration present. A "young" soft and juicy disc, will often shrink, spread, or smooth out with in the spinal canal. Thus once again no longer compressing adjacent neural structures. As this happens, the patients leg pain steadily resolves. Unfortunately, the disc which ruptures is not healthy, and thus often already presenting with signs of degeneration. A degenerating disc is characterized by progressive shrinkage, drying, cracking , and hardening. Because these degenerated disc are inherently weaker, they are often the disc which rupture following accidents. {In fact it has been well demonstrated that healthy disks are generally stronger than the vertebral bones they serve to cushion. That is why in more severe trauma, the back bones surrounded by healthy discs, will fracture.}

Compare to the Bulging Disk.

Indications for Surgery!