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.

In order for us to better understand the function of the disc think of the jelly doughnut again. What do you think would happen if you put some pressure on the front end of that doughnut? The pressure would force the jelly to move towards the back end. Of course, the exact opposite would occur if the pressure were on the other side. Your disc is no different since it acts as a fulcrum for movement. When a disc prolapses the jelly starts to ooze out and can put pressure on near by nerve fibers. This causes symptoms most commonly known as sciatica or radiculopathy such as numbness and tingling.

As we get older our tissues dehydrate and this limits the shock absorbing capacity of the disc. The annular fibers get weaker with age and begin to tear more easily when subjected to repetitious stress. In many cases this doesn’t cause pain, while in some is does.

In Medicine one generally refers to the gradual dehydration of the nucleus pulposus as degenerative disc disease or if accompanied by bony changes; spondylosis.

When the annulus fibrosus tears due to an injury or the aging process, the nucleus pulposus can begin to extrude through the tear. This is called disc herniation. Near the posterior side of each disc, all along the spine, major spinal nerves extend out to different organs, tissues, extremities etc. It is very common for the herniated disc to press against these nerves (pinched nerve) causing radiating pain, numbness, tingling, and diminished strength and/or range of motion. In addition, the contact of the inner nuclear gel, which contains inflammatory proteins, with a nerve can also cause significant pain. Nerve-related pain is called 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. Protruded Disc

2. Extrustion

3. Sequestered Disc

Up until a few years ago surgery was the only option for those who failed therapy. A gap between these two groups left no other options for those who failed therapy. Soon you will learn about a new option that bridges the gap between failed therapy and surgery.

If you’ve failed conventional therapy at that point surgery is usually investigated as an option. However, the presence of incontinence, weakness and numbness of genital regions or function is known as cauda equina and considered an emergency situation requiring surgical intervention.

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.” Recently, additional randomized controlled clinical trials have refined the indications for surgical interventions.

Surgical intervention should be a last resort only after all other means have been exhausted.

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Filed under back pain by Gordon Kuang on Dec 11th, 2009.

What You Need To Know About Spine Surgery

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