Why Spine Surgery Should Be Your Last Resort
Posted on December 21, 2009
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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.
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.).
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.
The medical term for disc which have begun to dehydrate is known as degenerative disc disease and if severe enough may be accompanied by bony changes termed 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.
Herniated discs are often referred to by any of the following names such as a slipped disc, ruptured disc, or a bulging disc. In medical terms there are three degrees of disc injury:
1. Protrustion
2. Extruded Disc
3. Sequesteration
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.
Regarding the role of surgery for failed medical therapy in patients without a significant neurological deficit, 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”. More recent randomized controlled trials refine indications for surgery.
Only after all other means have been exhausted should surgery be considered as an option.
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