Herniated Disc Queens, New York (NY)
An Intervertebral Disc, or Spinal Disc, has two main components. The first, the annulus fibrosis, is the outer layer. This can be likened to the dough part of a jelly doughnut. The second, inner layer, comparable to the jelly portion of a jelly doughnut is known as the nucleus polposus. The inner nucleus portion functions primarily as a fulcrum for movement and as a shock absorber to handle the impacts of movement.
To better understand how a disc functions we often compare it to a jelly doughnut. If you put pressure on one end, say the front end, of a doughnut you could imagine that the jelly would migrate towards the back. If you put pressure on the back end, the opposite would occur, and the jelly would migrate towards the front. The same holds true for your intervertebral disc since it functions as a fulcrum. When the jelly starts to protrude from the confines of the annular fibers this is known as a prolapse. This can cause symptoms of sciatica or radiculopathy such as numbness and tingling down an extremity.
Herniated and Degenerative Disc Disease
As people age, the nucleus pulposus begins to dehydrate, which limits its ability to absorb shock. The annulus fibrosus gets weaker with age and begins to tear as a result of repetitive stress as well as the aging process. This doesn’t always cause pain for all people although it can for some.
In Medicine one generally refers to the gradual dehydration of the nucleus pulposus as degenerative disc disease or if accompanied by bony changes; 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.
Disc can become slipped, ruptured, or bulged. However, in medical terms it is more commonly referred to as:
2. Extruded Disc
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.
Surgery should be considered if a patient has a significant neurological deficit, or if they fail non-surgical therapy. The presence of cauda equina syndrome (in which there is incontinence, weakness and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression.
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.
Surgical intervention should only be considered after all other forms of non-surgical intervention have been exhausted.