Overview The shock-absorbing discs that separate the bones
in the spine are probably the most common reason for spine surgery.
The disc is much like a jelly doughnut, in that there is an outside
wall to the disc and a soft center. The “jelly” is the
inner spongy portion of the disc, called the nucleus pulposus. Encircling
the jelly nucleus are hard bands of fibrous tissue called the annulus
fibrosis, or disc wall.
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Causes With age, the disc can become more brittle and susceptible to herniation
or rupture. Years of strain, and poor body lifting form, can take
a toll. One day, a sudden stress from lifting can cause this weakened
disc to rupture, allowing the jelly center to squirt out of the disc
space. This jelly contains chemicals which are extremely irritating
to the nerves, which can also cause swelling.
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Symptoms Because the nerve roots act as telegraph lines to other parts of the
body, a common complication of disc herniation is that it can cause
pain that is felt in other parts of the body, like the leg. In fact,
leg pain below the knee is a common herniated disc symptom. This
radiating pain is called radicular pain or radiculopathy.
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Diagnosis Your physician will request diagnostic testing to help determine the
best treatment plan.
X-rays are usually the first step in diagnostic
testing methods. X-rays show bones and the spaces between the bones.
MRI (Magnetic Resonance Imaging) uses a magnetic
field and radio waves to generate highly detailed pictures of the
inside of your body. Because X-rays only show bones, MRIs are needed
to see soft tissues like spinal discs. These images help your doctor
provide a more accurate diagnosis. MRIs are very safe and usually
pain-free.
CT scan/myelogram - A CT scan is similar to an MRI
because it provides additional diagnostic information about the
internal structures of the spine. A myelogram is used to diagnose
a bulging disc, tumor or changes in the bones surrounding the spinal
cord or nerves. A local anesthetic is injected into your low back
to numb the area. A lumbar puncture (spinal tap) is then performed.
A dye is injected into the spinal canal to reveal where problems
lie.
Electrodiagnostic - Electrical testing of the nerves
and spinal cord may be performed as part of our diagnostic workups.
These tests, called Electromyography (EMG) or Somato Sensory Evoked
Potentials (SSEP), assist your physician in understanding how your
nerves or spinal cord are affected by your condition.
Bone scan - Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any area of the body. Bone
scans are also used to find lesions for biopsy or excision. Click
here to learn more about bone scans.
Discography - Discography is used to determine
the internal structure of your disc. It is performed with a local
anesthetic by injecting dye into the disc under X-ray guidance.
An X-ray or CT scan is performed to determine if the disc’s
structure is normal or abnormal and if the injection causes pain.
A benefit of a discogram is that it enables the spine surgeon to
determine the disc level that is causing pain. This ensures that
surgery will be more successful by reducing the risk of operating
on the wrong disc.
Injections - Pain-relieving injections can act
as a bridge to physical therapy by relieving back pain and providing
the physician with important information about your problem.
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Treatment Unlike muscles which can heal somewhat quickly, a torn or degenerated
disc heals more slowly. The good news is that in many cases, the
pain and inflammation originating from damaged discs can be treated
nonsurgically by reducing the inflammation and by strengthening the
musculature surrounding the damaged disc to give it more support.
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FAQs What is degenerative disc disease?
A natural byproduct of aging is the loss of resiliency in spinal discs
and a greater tendency for them to herniate, especially when placed
under a weighty load, like when we lift heavy objects. Additionally,
some people have a family history of degenerative disc disease, which
increases their own risk of developing it. When a natural disc herniates
or becomes badly degenerated, it loses its shock-absorbing ability,
which can narrow the space between vertebrae.
Who is a candidate for the artificial disc?
Patients with a diseased disc between L4 and L5 or between L5 and S1
(all in the lower back) that is worn out or become injured and causes
back pain are candidates for the artificial disc. Other candidates
include those with degenerative disc disease (DDD) whose bones (vertebrae)
have moved less than 3mm. Your physician will help you determine
whether or not the artificial disc is a good choice for you. Factors
that will be considered include your activity level, weight, occupation
and allergies.
What are the benefits of the artificial disc?
Generally speaking, those who receive artificial disc replacements
return to activity sooner than traditional fusion patients. Also,
because there is no need to harvest bone from the patient’s
hip, there is no discomfort or recovery associated with a second
incision site. Some of the overall benefits of artificial disc surgery
include:
Retains movement and stability of the spine
Prevents degeneration of surrounding segments
No bone graft required
Quicker recovery and return to work
Less invasive and painful than a fusion
Reduces pain associated with disc disease
What caused my disc to herniate? Herniated discs can occur as a result of a heavy strain or fall, which
causes the nucleus to break through the wall of the disc and place
pressure on the nerves that branch out from the spinal cord. For
example, lifting a heavy object after sitting down for a long period
of time can cause a disc to herniate.
What is the best way to treat a herniated disc? Nonsurgical treatment methods are always the best option to try first.
This will most likely involve working with a physical therapist who
will develop a customized exercise program involving specific stretches
and extension movements for you.
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