Spinal disc issues are difficult to understand – and often misunderstood – for a number of reasons. For instance, medical professionals do not always agree on pain causation as related to the spinal disc, and patients often have a difficult time understanding this very complex medical topic, which is often under explained as well.
What is a Spinal “Disc”?
Spinal discs are a key component of the human spine. The spinal disc is made of a tough outer layer called the “annulus fibrosus”, combined with an inner gel-like center called the “nucleus pulposus”. The discs also have a strong connective tissue, which join one vertebra to the next by attaching securely to the vertebrae above and below them. Spinal discs are round in diameter and they are flat on the top and bottom. The discs have somewhat of a “shock absorption” property and act as a “cushion” between the vertebrae. Because of the many stresses sustained by the spine over time, along with changes due to aging, the spinal disc is susceptible to injury. These injuries can lead to lower back pain, leg pain, along with other similar symptoms such as numbness and weakness.
Non-Surgical Treatment Options
There are a variety of non-surgical treatment options available including physical therapy, injection of an anti-inflammatory steroid, and radiofrequency rhizotomy. These forms of non-surgical treatments may be prescribed by your spinal doctor, however when non-surgical treatment techniques fail to resolve the underlying issue, your spinal doctor may turn to surgical means of treatment. Your surgeon will choose the proper level of treatment for your particular case, be it surgical or non-surgical. This is done by considering the patient’s unique symptoms, as well as the location and direction of the disc derangement by using magnetic resonance imaging (MRI).
Generally considered the most common surgical treatment for a disc disorder is the spinal laminectomy, sometimes referred to as “decompression surgery “. The laminectomy is a technique that creates space and enlarges your spinal canal to “decompress” the spinal cord or nerves. The lamina (the posterior arch of bone covering the neural tissue of the spine) of the spinal vertebra is removed with the intent of relieving pressure on the nerve to alleviate pain, numbness, or weakness. A laminectomy is often effective in relieving nerve pain in the limbs and in many cases it successfully alleviates spinal pain as well.
Spinal fusion is a surgical procedure that involves fusing together two vertebrae to create one solid piece of bone. When the discs degenerate to the point where the structural stability of the vertebra is adversely affected in such a way that excess motion causes back pain and the loss of disc height causes nerve root compression, then disc fusion surgery may be in order. This procedure fuses the vertebrae, preventing motion between them and also prevents the stretching of the surrounding muscles, nerves and ligaments, which can be a source of pain. Fusions are generally recommended only when your doctor can accurately identify the source of the pain, often with the help of MRI and/or CT scans.
Although spinal fusions can reduce spine flexibility, the procedure generally does not inhibit motion. Fusions usually involve small portions of the spine and the procedure can be performed from the posterior (back) or the anterior (front). Bone grafts are implemented to assist the two vertebrae in fusing together, and rods, screws and plates may be used to provide added stability.
Following a spinal disc fusion, patients are not allowed to twist, lift or bend for several months and must follow precautions given by their surgeon in order to allow the graft to fully “take” and the fusion to heal successfully. Pool exercise is common during recovery as well as therapeutic core stabilization exercises, which are performed in a neutral spinal position. These exercises are designed to strengthen the lumbar and abdominal muscles without putting undue stress on the fusion itself. As with all recovery activities they should be carefully prescribed by your physician or physical therapist following a surgical procedure of this magnitude.
Spinal Disc Replacement Surgery
Spinal disc replacement is another type of spinal surgery, similar to a spinal disc fusion but different in one main function: a pivot type mechanism is used between the vertebra allowing limited spinal motion while simultaneously stabilizing the spinal segment and separating the vertebral elements, essentially giving the same “free space” as spinal fusion and unpinching nerves causing pain. An artificial disc (or “disc prosthesis”) is the device that is implanted into the spine to replace the original disc and provide the functions of a normal disc.
Treatment of spinal conditions is usually a progressive path, starting with therapies and non-surgical techniques that escalate to minimally invasive surgical techniques and potentially full surgery based on the patients particular diagnosis and treatment effectiveness. In severe of cases, surgical intervention may be the only alternative to alleviate a patient’s pain.
Spinal surgery of any kind is a big decision and should not be taken lightly. Choosing a qualified and experienced spinal surgeon is crucial for determining the proper treatment for your condition and performing the surgery if that is the prescribed treatment option.
For more information, consider a consultation with Dr. Joshua Rovner of Progressive Spine. Contact him here: http://www.newjerseyspinesurgeon.com/contact.