What You Need To Know About Spine Surgery
An Intervertebral Disc is made up of two primary components. The first is the outer layer of fibers known as the annulus fibrosus. Think of this as the ‘dough’ in a jelly doughnut. The second portion is the inner material known as the nucleus polposus which can be compared to the ‘jelly’ portion of the doughnut. The nucleus of the disc acts as a shock absorber, and a fulcrum, absorbing the impact of the body’s daily activities and keeping the two vertebrae separated.
To better understand how a disc functions we often compare it to a jelly doughnut. If you put pressure on one end, say the front end, of a doughnut you could imagine that the jelly would migrate towards the back. If you put pressure on the back end, the opposite would occur, and the jelly would migrate towards the front. The same holds true for your intervertebral disc since it functions as a fulcrum. When the jelly starts to protrude from the confines of the annular fibers this is known as a prolapse. This can cause symptoms of sciatica or radiculopathy such as numbness and tingling down an extremity.
As people age, the nucleus pulposus begins to dehydrate, which limits its ability to absorb shock. The annulus fibrosus gets weaker with age and begins to tear as a result of repetitive stress as well as the aging process. This doesn’t always cause pain for all people although it can for some.
The medical term for disc which have begun to dehydrate is known as degenerative disc disease and if severe enough may be accompanied by bony changes termed spondylosis.
When the annular fibers tear as a result of aging or injury to the area, the nucleus can begin to migrate through the tear. This is known as a herniated nucleus pulposus. Near the back side of each disc are major spinal nerves that extend outward t the organs, tissues, extremities and other body parts they control and innervate. It is quite common for the herniated disc to press against these nerves and cause pain, numbness or tingling down the affected area often termed a ‘pinched nerve’. Also worth noting is the fact that the inner jelly material is very inflammatory and so whatever it comes in contact with will likely become inflamed and cause significant pain. If the pain is nerve related it is generally referred to as radicular pain.
A disc injury can be termed any of the following, depending on it’s severity; slipped disc, ruptured disc, bulging disc. In medicine there are three degrees of injury that can occur to a disc:
1. Protrustion
2. Extruded Disc
3. Disc sequestration
Until recently surgery was one of the only options for such a condition other then therapy. There has been a therapy gap – ‘no mans land’ – in spinal care since many people who are not surgical candidates do not respond to conventional therapy. Soon you will read about a new option that helps to bridge this gap.
Surgery may be an option for those with significant neurological deficit that have failed therapy. Additionally, the presence of sever neurological symptoms known as cauda equina syndrome is considered a surgical emergency requiring immediate attention.
Regarding the role of surgery for failed medical therapy in patients without a significant neurological deficit, a meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that “limited evidence is now available to support some aspects of surgical practice”. More recent randomized controlled trials refine indications for surgery.
Only after all other means have been exhausted should surgery be considered as an option.
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