Disk Problems

It can happen to anyone, anytime, anywhere, and chances are it has probably happened to you at some point in your life. Back pain can come on suddenly or creep up on you. (Read about "Back Pain") It might stay a while, or fade quickly. Sometimes it's serious, and other times it's just a minor ache. Back pain is the second most common neurological ailment in the United States, with headaches taking first place (Read about "Headaches"), according to the National Institute of Neurological Disorders and Stroke, (NINDS). It probably won't surprise you to learn the lower back is where most back pain is felt. That's because the lower back is the area that supports the weight of your entire upper body. The American Academy of Orthopaedic Surgeons (AAOS) says Americans spend $50 billion dollars a year on low back pain.

Back basics

The back is stacked with 24 bones called vertebrae. (Read about "The Spine") The spinal cord and nerves travel through the spinal canal and communicate between the brain and muscles. (Read about "Nervous System" "The Brain") Disks sit between the vertebrae and act as shock absorbers. They are flat and round and have a tough outer ring and a jellylike center. When something goes wrong with a disk, pain is likely to follow. There are two main types of disk problems:

• herniated disks
• degenerative disks

Degenerative disk disease

Degenerative disk disease, or DDD, is part of the aging process, according to AAOS. Disks typically have a high water content when we are young, but as we age, they tend to dry out and weaken. The disks begin to shrink and the spaces between the vertebrae narrow. As a result, nerve roots are compressed which can cause pain. Sometimes the disks may collapse and the facet joints start rubbing onto one another. This can result in pain and stiffness. AAOS says the wear and tear on the facet joints can lead to osteoarthritis. (Read about "Osteoarthritis")

Symptoms of degenerative disk disease can vary. Sometimes it may feel like a cramp or sore muscle, according to AAOS. Many will find that when they are lying down, they feel better. Other symptoms of DDD may include:

• sciatica
• pain down the buttock and hip, but not the leg
• pain that comes and goes
• pain that is worse when standing, walking or sitting
• difficulty bending and lifting

Unfortunately there is no known cause or cure for DDD, but there are ways to treat the pain. (See treatment below)

Herniated disks

If you've been diagnosed with a bulging, ruptured or slipped disk, then you have a herniated disk. A disk can rupture when part of the soft center pushes through the outer edge toward the spinal canal. According to AAOS, this puts pressure on the already sensitive spinal nerves. Once the jellylike nucleus of the disk breaks through the outer ring, the pain in the back subsides. The pain in the leg, however, increases according to AAOS. A lumbar herniated disk is one of the most common causes of low back pain as well as leg pain. Other low back pain symptoms associated with a lumbar herniated disk may include:

• leg pain that typically involves the leg below the knee
• numbness
• weakness
• tingling in one leg or buttock
• loss of bowel or bladder control - if this occurs you should seek immediate medical care.

If the herniated disk is in the upper part of your spine or the cervical area, it can result in neck pain. AAOS says that when pressure is placed on a nerve in the neck, pain radiates between your neck and shoulder and sometimes down your arm. It can cause headaches in the back of the head as well as:

• weakness in one arm
• tingling and/or numbness down one arm
• burning pain in neck shoulder or arm

Back pain risks

AAOS reports that 60 to 80 percent of all people will experience low back pain at some point in their lives. You can help prevent future problems by knowing some of the risk factors:

• aging - the older we get, the weaker the disks of the back become
• lifestyle - the more sedentary you are the more likely you are to suffer from back pain (Read about "Getting Started on Fitness")
• gender - men between the ages of 30 and 50 are more likely to have a herniated disk
• weight - being overweight puts strain on the disks of your lower back (Read about "Obesity")
• smoking - it's believed that smoking causes faster degeneration of disks due to a lessened oxygen supply (Read about "Quit Smoking")
• improper lifting - using the back instead of legs can cause a herniated disk
• frequent driving or sitting - being seated for long periods of time can put pressure on your spine and disks

Diagnosis

When pain is severe and doesn't seem to get any better, it's time to call in a physician. Diagnosing disk problems may involve some of the following, according to both AAOS and NINDS:

• a physical exam by your doctor
• a neurological exam to detect weakness or sensory loss
• an x-ray (Read about "X-rays")
• an MRI or CT scan (Read about "MRI - Magnetic Resonance Imaging" "CT Scan - Computerized Tomography")
• straight leg test, this is a very accurate predictor of a disk herniation
• blood tests
• bone scan
• bone density test (Read about "DEXA Scan - Dual Energy X-Ray Absorptiometry/Densitometry ")

Testing may not reveal the cause of your back pain, and often the cause is never known, according to NINDS. However, even without knowing the cause, you can get relief.

Treatment

Treatment for back pain is as vast as the many aches and pains themselves. NINDS lists seven different ways back pain is treated. Of course, it all depends on the severity of your pain. There are nonsurgical and surgical options. Here are just some of the options that NINDS lists:

Nonsurgical treatments

• hot or cold packs, sometimes both
• exercise - your doctor or physical therapist can give you some of the correct forms of exercise to help strengthen your back
• medication - everything from acetaminophen to nonsteroidal anti-inflammatory drugs and topical creams to muscle relaxants
• x-ray guided spinal injections such as steroids
• alternative treatments like massage, physical therapy, transcutaneous electrical stimulations (TENS) and acupuncture (Read about "Complementary and Alternative Medicine Therapies")

AAOS reports that nonsurgical treatments relieve symptoms of herniated disks in more than 90 percent of patients. The risks involved with non-surgical treatment are minor, according to AAOS. The only issue is that it may take a long time to feel any relief.

Surgical treatments

Surgery is only performed for the most chronic of back pains and when other treatments fail to work. NINDS says surgery may be recommended in severe cases of herniated disks. For example, when there is a leak of the jelly like center of the disk or when more than one disk is damaged.

Some surgical procedures include:

• Discectomy or microdiscectomy - A discectomy is surgery that removes part of a herniated disk, according to AAOS. A microdiscectomy uses a special instrument to view the disk and nerves, which makes it possible to use smaller incisions. These procedures can relieve some of the pressure that is causing either back or leg pain. AAOS says surgery is 90 percent successful if most of the pain is in the leg. The disk or another could rupture again however. In some cases, an artificial replacement disk might be an option, after the damaged disk is removed. An artificial disk can preserve motion, and may be an alternative to fusion as well. The Food and Drug Administration (FDA) says the artificial disk may help restore the natural distance between the two vertebrae, which may allow movement at the level where it is implanted. The new disk is placed in the spine through a small incision near the belly button. The diseased or damaged disk is removed and the artificial disk is placed in the space. Patients require general anesthesia, according to FDA. (Read about "Anesthesia")
• Spinal fusion - Spinal fusion is used to treat injuries, ruptured disks and scoliosis. Two or more vertebrae are fused together using bone and/or metal rods. It decreases the flexibility of the back. AAOS says over a quarter million spine fusions are done each year, with more done to the lower (lumbar) back than the upper (cervical) area.
• Laminectomy - Laminectomy is the removal of the bony area at the back of the vertebra, the lamina, to relieve pressure. It is often done in conjunction with discectomy and fusion.
• Laminotomy - Laminotomy is the partial removal of the bony area at the back of the vertebra, the lamina, to relieve pressure.
• Laminoplasty - Laminoplasty is the cutting of the bony area at the back of the vertebra, the lamina, and hinging it back to increase the size of the spinal canal. The lamina can be kept open through various techniques such as bone struts, sutures, metal plates or spacers and tension bands.
• Disk replacement - This involves removing the disk and replacing it with artificial parts.

The risk of surgical complications is considered low, according to AAOS. Complications may include infection, nerve damage, a leak of spinal fluid, and hematoma.

Prevention

Behavior changes are the key to better back health, according to NINDS. (Read about "Back Tips") Many of the factors that cause backaches are the very things we can modify. NINDS suggests the following:

• proper posture
• learning to lift and pull with legs, instead of your back
• exercising or changing exercise habits
• relaxation
• eating a healthy diet
• quitting smoking
• more sleep

In the case of back pain, an ounce of prevention really is worth a pound of cure.