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.

To learn more about how the disc does this think of that jelly doughnut. Now, I want you to imagine what would happen to the jelly if you put some pressure on the front end of the doughnut. The jelly would migrate or move towards the back. The opposite would occur if you put pressure on the back portion of the doughnut. The disc functions in a similar manner and acts as a fulcrum upon which movement can occur. When one develops a prolapsed disc the jelly/ nucleus pulposis is forced out of the doughnut/ disc and may put pressure on the nerve located near the disc. This will give one the symptoms of sciatica or a corresponding radiculopathy (numbness/tingling/shooting pain/etc.).

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 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. Disc Protrusiton

2. Disc Extrusion

3. Sequestered Disc

Surgery used to be the only options if others therapies failed. Until recently there has been a gap between conventional therapy and surgery. Now, there is a new options for those who are trying to avoid surgery that you will soon read about.

Surgery may be an option for those with significant neurological deficit that have failed therapy. Additionally, the presence of sever neurological symptoms known as cauda equina syndrome is considered a surgical emergency requiring immediate attention.

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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