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.
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 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.
Disc can become slipped, ruptured, or bulged. However, in medical terms it is more commonly referred to as:
1. Protruded Disc
2. Extruded Disc
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.
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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