If You’re Considering Spine Surgery You Need To Read This First

An Intervertebral Disc, or Spinal Disc, has two main components. The first, the annulus fibrosis, is the outer layer. This can be likened to the dough part of a jelly doughnut. The second, inner layer, comparable to the jelly portion of a jelly doughnut is known as the nucleus polposus. The inner nucleus portion functions primarily as a fulcrum for movement and as a shock absorber to handle the impacts of movement.

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.

The nucleus of the disc will begin to dry out as we age and this will hinder it’s ability to absorb shock properly. Along with a weakening annular fiber, with age, we see more frequent tears which result from repetivie stress to the weakened tissues. This causes pain for some, but not in all cases.

When the discs of the spine begin to dehydrate this is known as degenerative disc disease, and if bony changes accompany this process it’s often referred to as arthritic changes or 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. 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 should be considered if a patient has a significant neurological deficit, or if they fail non-surgical therapy. The presence of cauda equina syndrome (in which there is incontinence, weakness and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression.

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 only be considered after all other forms of non-surgical intervention have been exhausted.

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