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.
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.
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.
Once a tear has arisen within the annular fibers it is highly likely that the inner nuclear material will begin to make it’s way through that tear. This is termed a herniation. All along the sides of the spine are nerve roots and spinal nerves that make their way to organs, tissues and other body parts and they are at high risk of being infringed upon by herniated disc material. A pinched nerve is when this herniated disc material begins to make contact with one or more affected nerve roots and may cause severe radiating pain, numbness, tingling and reduced ranges of motion. One can also suffer pain as a result of a ‘leaky’ disc where the jelly simply oozes out of the tear and begins to cause inflammation in the adjacent soft tissues. If the pain is nerve related it’s usually deemed a radiculopathy.
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. Protrustion
2. Disc Extrusion
3. Sequesteration
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.
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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