A ruptured disc, also sometimes referred to as a “slipped” or “herniated” disc, occurs when a tear or weakness in an intervertebral disc’s protective outer layer allows the inner layer to leak through its barrier and into the spinal canal. This can put pressure on area nerves, causing pain, discomfort and other complications. Ruptured discs are one of the most common underlying causes of sciatica and lower back pain, the latter of which is leading cause of work-related disability in the United States.
Aging, general wear and tear and deteriorative conditions, such as degenerative disc disease, are by far the most common causes of ruptured discs. However, several elements may encourage or intensify a ruptured disc, including:
- Sudden injury, trauma or accident, such as that which may occur in a car crash, high-impact sport, hard fall or blow to the back
- Frequent, improper movements or lifting, often incurred by individuals whose jobs require highly physical labor or driving long distances
- Obesity or excess weight
- Lack of exercise or regular activity
- Smoking and the excessive use of alcohol
- Gender (men between the ages of 30 and 50 are highly prone to painful herniated discs)
- Family history, genetics and congenital spine abnormalities
Patient symptoms can differ and are dependent on where the ruptured disc is located within the spine. Usually individuals with a ruptured disc notice few changes until the displaced disc tissue begins to aggravate surrounding components of the body. Once there is pressure on a nerve, symptoms that may arise include:
- Dull, achy pain or sharp, intense pain
- Muscle tightness and cramping
- Pain that radiates through the shoulders and arms or down the legs
- Tingling and pins-and-needles sensations through the arms and hands or up and down the legs
- Weakness in the affected area and limbs
Because the symptoms of a ruptured disc closely mirror many other spine conditions including cancer, spinal stenosis and bone spurs, it is important to obtain a comprehensive diagnosis as soon as possible. If you are unsure of the exact point from which your pain extends, we are able to use advanced pain-mapping techniques to pinpoint the precise location at which your discomfort is stemming.
In rare cases, a ruptured disc may begin to compress the spinal cord itself, which can be very dangerous. Individuals who experience fever or incontinence of the bladder or bowels should call 911 immediately, as a medical emergency may be occurring.
Cervical spondylosis, also known as cervical (neck) arthritis, is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).
Cervical spondylosis is very common and worsens with age. More than 85 percent of people older than age 60 are affected by cervical spondylosis.
Most people experience no symptoms from these problems. When symptoms do occur, nonsurgical treatments often are effective.
Cervical osteoarthritis becomes more common as people age, so the natural wear and tear sustained by the facet joints over time is considered to be a major factor in its development. However, the medical community continues to study the issue and other factors also appear to play a role in the development of osteoarthritis, including:
- Genetics. Some evidence suggests that osteoarthritis can run in families, which would indicate some people are genetically predisposed to having cartilage that breaks down sooner.
- Injury. If the joint becomes injured, such as a tear in the cartilage and/or protective joint capsule, the joint can become more inflamed and cartilage can wear down sooner. Joint injuries can happen in various ways, such as from a fall or while participating in a sport.
- Occupation. Certain occupations, such as jobs that involve lots of repetitive motions or heavy lifting like construction, can put more stress on the cervical spine.
- Weight. People who are overweight tend to develop osteoarthritis sooner, including in the neck. More weight means more stress on the joints, but another possibility could be that people with excess weight might experience more damaging inflammation.
Currently, the medical literature has limited data on whether or not smoking contributes to osteoarthritis in the spine. However, smoking has been linked to increasing neck pain in general.
For most people, cervical spondylosis causes no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck.
Sometimes, cervical spondylosis results in a narrowing of the space needed by the spinal cord and the nerve roots that pass through the spine to the rest of your body. If the spinal cord or nerve roots become pinched, you might experience:
- Tingling, numbness and weakness in your arms, hands, legs or feet
- Lack of coordination and difficulty walking
- Loss of bladder or bowel control
Lower Back Arthritis
While any part of the back can be affected, the lower back is the most common site of arthritis back pain, most likely because it bears more of the body’s weight.
Several forms of arthritis – collectively referred to as the spondylarthropathies (meaning spinal arthritis)– primarily affect the spine. These include:
• Ankylosing spondylitis. Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine, particularly the sacroiliac joints near the pelvis, and the hip joints. Ankylosing is a term meaning stiff or rigid and spondylitis means inflammation of the spine.
Enthesitis (inflammation of the place where ligaments and muscles attach to bones) accounts for much of the pain and stiffness of ankylosing spondylitis. This inflammation eventually can lead to bony fusion of the joints (where the fibrous ligaments transform to bone, and the joint permanently grows together).
Other joints can also develop synovitis (inflammation of the lining of the joint), with lower limb joints more commonly involved than upper-limb joints.
• Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder.
• Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage the joint disease develops before the skin disease. For about 20 percent of people with psoriatic arthritis, the disease involves the spine. In some cases, bony overgrowth can cause two or more vertebrae to grow together, or fuse, causing stiffness.
• Juvenile Spondylarthropathy. Also called juvenile-onset spondyloarthritis (spinal arthritis), this term is used to describe spondylarthropathies that begin before age 16. In addition to affecting the spine, they may cause pain and inflammation in the joints of the pelvis, hips, ankles and knees. They may also affect other body organs such as the eyes, skin and bowels.
• Enteropathic arthritis. This is a form of arthritis that occurs in about 5 percent of people with inflammatory bowel disease, which includes ulcerative colitis and Crohn’s disease. It commonly affects the sacroiliac joints, causing lower back pain.
Other forms of arthritis and related conditions that can affect the back include:
• Osteoarthritis. The most common form of arthritis of the back, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. In the spine, this breakdown occurs in the cartilage of the facet joints, where the vertebrae join. As a result, movement of the bones can cause irritation, further damage and the formation of bony outgrowths called spurs. These spurs can press on nerves, causing pain. New bone formation can also lead to narrowing of the spinal canal, known as spinal stenosis.
• Rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disease of the joints that occurs when the body’s immune system – which normally protects us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. Although rheumatoid arthritis most commonly affects the hips, knees, hands, wrists, feet, elbows and ankles, it can also affect the facet joints in the spine, causing pain and, in severe cases, destruction of the joints. This may allow the upper vertebra to slide forward on top of the lower vertebra, a condition called spondylolisthesis. The slipped vertebra may put pressure on the spinal cord and/or the nerve roots where they exit the spine.
• Gout. Gout is a form of arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee. Less commonly gout can affect the spine, causing extreme pain, numbness and tingling. It can be confused with a spinal infection.
• Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within a joint. It can occur in the facet joints of spine. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi.
• Polymyalgia rheumatica. An inflammatory disorder that causes widespread muscle pain and stiffness, polymyalgia rheumatica mainly affects the neck, shoulders, upper arms, lower back, thighs and hips. The disease often comes on suddenly and resolves on its own in a year or two.
• Fibromyalgia. An arthritis-related condition, fibromyalgia is a syndrome of chronic, widespread muscle pain and fatigue, which can be debilitating. The lower back is a common site of fibromyalgia pain.
• Osteoporosis. Osteoporosis is a condition in which the bones loose so much mass that they become brittle and prone to break with slight trauma. The condition, which can occur with aging, inactivity, a low-calcium diet or use of corticosteroid medications, commonly affects the spine. When this occurs in the spine, the inner spongy bone and more solid outer portion of the vertebrae become porous. The weakened vertebrae can break – an injury called a compression fracture – and lose about one-half of their height. In most cases, compression fractures, are painful. In some cases, the resulting back pain is severe. Usually, the pain resolves within a few weeks, but for some people, it is long-lasting.
• Spinal stenosis. Literally meaning "spinal narrowing," spinal stenosis can occur when changes in arthritis lead to bony overgrowth of the vertebrae and thickening of the ligaments. This can occur with osteoarthritis or ankylosing spondylitis. If a significant overgrowth occurs, it can cause the spinal column to narrow and press on the nerves housed within. Because the affected nerves have many functions, the condition may cause diverse problems in the lower body, including back pain, pain or numbness in the legs, constipation or urinary incontinence.
• Paget’s disease of bone. Paget’s disease is a chronic disorder in which excessive breakdown and formation of bone causes the bones to become enlarged, misshapen and weakened. The disease usually does not affect the entire skeleton, but just one or a few bones. The vertebrae are among the bones most commonly affected by Paget’s disease.
• Sciatica. This is inflammation of the sciatic nerve. The largest nerve in the human body, the sciatic nerve runs from the lower part of the spinal cord, through the buttock and down the back of the leg to the foot. The most common causes of sciatica include compression of the nerve where it exists the spine by a herniated disc, or a rupture of one of the structures that cushions the vertebrae in the spine. Sciatica may be felt as a sharp or burning pain that radiates from the hip. It may also be accompanied by low back pain.
• Scoliosis. Instead of running straight up the center of the back, a spine with scoliosis twists to one side. Scoliosis can be classified as true (meaning it has to do with abnormal development of the spine) or functional (meaning its cause is not directly related to the spine). Functional scoliosis may occur when a discrepancy in leg length causes the pelvis to tilt to one side to compensate. The cause of true scoliosis is largely unknown, although doctors suspect that it may be the result of imbalanced growth in childhood.
Osteoarthritis pain in the lumbar region (lower back) can stem from nerve irritation from a herniated disc or from bone spurs and can cause weakness, numbness, tingling and/or pain in the legs that often radiates to the feet. Arthritis causing spinal stenosis, or narrowing of the spinal canal, in the lower back can cause pain in both legs and may lead to difficulty walking.
Arthritis of the spine is a degenerative spine condition that causes inflammation, swelling and stiffness in the facet joints of the spine. Because the facet joints allow the vertebrae of the spine to hinge and move, any swelling or inflammation in the joints can limit mobility in the spine.
Additional symptoms of arthritis of the spine include:
- Back pain that comes and goes
- Spinal stiffness in the morning after getting out of bed or after activity. Often this pain decreases with rest or, for some, after exercise
- Pain, tenderness or numbness in the neck, if nerve compression is involved
- In lower back pain, there may be a weakness or numbness that runs down into the buttocks, thighs or pelvic area
- Pain or tenderness in the shoulders, hips, knees or heels or at the joint in the spine
- A crunching feeling or sound of bone rubbing on bone
- Limited range of motion, difficulty bending or walking
- Spinal deformity or abnormal curvature
- Swelling and warmth in one or more joints, particularly during weather changes (which may be related to barometric pressure changes and cooling of the air)
- Steady or intermittent pain in a joint, which is often described as an aching type of pain
- A sensation of pinching, tingling or numbness in a nerve or the spinal cord, which can occur when bone spurs form at the edge of the joints of the spine and irritate the nerves
Cervical spinal stenosis is the narrowing of the spinal canal in the neck – or the narrowing of the open area in the bones (vertebrae) that make up the spinal column. A collection of nerves runs through the spinal canal from the base of the brain to the lower back. These nerves allow us to feel, to move, and to control the bowel and bladder and other body functions. In cervical spinal stenosis, the spinal canal narrows and can squeeze and compress the nerve roots where they leave the spinal cord, or it may compress or damage the spinal cord itself. The seven vertebrae between the head and the chest make up the cervical spine. Squeezing the nerves and cord in the cervical spine can change how the spinal cord functions and cause pain, stiffness, numbness, or weakness in the neck, arms, and legs. It can also affect your control of your bowels and bladder.
Cervical spinal stenosis is usually caused by age-related changes in the shape and size of the spinal canal and therefore is most common in people older than age 50. The aging process can cause a “bulging of the discs” – or a thickening of tissues that connect bones (ligaments). Aging can also lead to destruction of tissues that cover bones (cartilage) and excessive growth of the bones in joints. These conditions can narrow the spinal canal (spinal stenosis).
In rare cases, the spinal canal is narrowed from birth because of the way the bones are formed.
Many people older than age 50 have some narrowing of the spinal canal but do not have symptoms. Cervical spinal stenosis does not cause symptoms unless the spinal cord or nerves becomes squeezed. Symptoms usually develop gradually over a long period of time and may include:
- Stiffness, pain, numbness, or weakness in the neck, shoulders, arms, hands, or legs.
- Balance and coordination problems, such as shuffling or tripping while walking. Cervical spinal stenosis can be crippling if the spinal cord is damaged.
- Loss of bowel or bladder control (incontinence).
Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as the lumbar area. This usually happens when bone or tissue-or both-grow in the openings in the spinal bones. This growth can squeeze and irritate nerves that branch out from the spinal cord .
- Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. …
- Herniated disks. …
- Thickened ligaments. …
- Tumors. …
- Spinal injuries
Overall, spinal stenosis symptoms are often characterized as:
- Developing slowly over time, or slow onset
- Coming and going, as opposed to continuous pain
- Occurring during certain activities (such as walking for lumbar stenosis, or biking while holding the head upright) and/or positions (such as standing upright for lumbar stenosis)
- Feeling relieved by rest (sitting or lying down) and/or any flexed forward position.