A Spinal Disc has two main components that make up it’s structure. There is an outer later made up of fibro-cartilage known as the annulus fibrosis. This is comparable to the dough in a doughnut. There is also an inner layer known as the nucleus polposus which is a jelly like material which would be the jelly inside the doughnut. The nucleus portion of the intervertebral disc is a shock absorber that also acts as a fulcrum for movement that redistributes the impact from daily stress and movement as well as spacing between two adjacent vertebrae.
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.
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. 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.
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.
The Cochrane Collaboration, after a meta-analysis or randomized controlled trials, concluded that “limited evidence is now available to support some aspects of surgical practice.” Indications for surgery have been refined as a result of these findings and additional controlled trials.
Only after all other means have been exhausted should surgery be considered as an option.
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