DISC PROBLEMS

Overview

The shock-absorbing discs that separate the bones in the spine are probably the most common reason for spine surgery. The disc is much like a jelly doughnut, in that there is an outside wall to the disc and a soft center. The “jelly” is the inner spongy portion of the disc, called the nucleus pulposus. Encircling the jelly nucleus are hard bands of fibrous tissue called the annulus fibrosis, or disc wall.

Causes

With age, the disc can become more brittle and susceptible to herniation or rupture. Years of strain, and poor body lifting form, can take a toll. One day, a sudden stress from lifting can cause this weakened disc to rupture, allowing the jelly center to squirt out of the disc space. This jelly contains chemicals which are extremely irritating to the nerves, which can also cause swelling.

Symptoms

Because the nerve roots act as telegraph lines to other parts of the body, a common complication of disc herniation is that it can cause pain that is felt in other parts of the body, like the leg. In fact, leg pain below the knee is a common herniated disc symptom. This radiating pain is called radicular pain or radiculopathy.

Diagnosis

Your physician will request diagnostic testing to help determine the best treatment plan.

X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the spaces between the bones.
MRI (Magnetic Resonance Imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Because X-rays only show bones, MRIs are needed to see soft tissues like spinal discs. These images help your doctor provide a more accurate diagnosis. MRIs are very safe and usually pain-free.
CT scan/myelogram - A CT scan is similar to an MRI because it provides additional diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
Electrodiagnostic - Electrical testing of the nerves and spinal cord may be performed as part of our diagnostic workups. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your physician in understanding how your nerves or spinal cord are affected by your condition.
Bone scan - Bone imaging is used to detect infection, malignancy, fractures and arthritis in any area of the body. Bone scans are also used to find lesions for biopsy or excision. Click here to learn more about bone scans.
Discography - Discography is used to determine the internal structure of your disc. It is performed with a local anesthetic by injecting dye into the disc under X-ray guidance. An X-ray or CT scan is performed to determine if the disc’s structure is normal or abnormal and if the injection causes pain. A benefit of a discogram is that it enables the spine surgeon to determine the disc level that is causing pain. This ensures that surgery will be more successful by reducing the risk of operating on the wrong disc.
Injections - Pain-relieving injections can act as a bridge to physical therapy by relieving back pain and providing the physician with important information about your problem.

Treatment

Unlike muscles which can heal somewhat quickly, a torn or degenerated disc heals more slowly. The good news is that in many cases, the pain and inflammation originating from damaged discs can be treated nonsurgically by reducing the inflammation and by strengthening the musculature surrounding the damaged disc to give it more support.

BULGING DISC

While herniated discs are often referred to as “slipped discs,” this really isn’t accurate because discs don’t ever slip out of position. They are actually attached by connective tissue to vertebrae above and below. A disc herniation can be “contained” or “uncontained.” With a bulge, for example, the jelly center remains within the disc wall. "Uncontained" means the jelly center has broken through the annulus wall but stays connected to the nucleus pulposus. Or the herniation can be “sequestered,” when it breaks free from the nucleus and travels away from the disc.

A bulging disc forms when the wall of the disc is deformed but not necessarily herniated. The nucleus is still contained in the wall. You NEVER need surgery to treat a bulging disc.

BONE SPUR

A bone spur, or osteophyte, is a projection of bone that develops and grows along the edge of joints. Bone spurs are fairly common in people over the age of 60. It is not the bone spur itself that is the real problem; pain and inflammation begin to occur when the bone spur rubs against nerves and bones.

HERNIATED DISC

The spine is composed of many vertebrae stacked on top of each other. Between these bones are discs, which act as shock absorbers. The shock-absorbing discs resemble jelly donuts, each having a jelly-like center. As we age, the discs naturally become less flexible and more brittle. Normal disc degeneration which naturally occurs with old age, can also cause pain.

Discs can herniate in any direction — forward, centrally or, most commonly, backward and sideways in the direction of the spinal nerves.

Herniated discs account for a small percentage of back pain.

DEGENERATIVE DISC DISEASE

Degenerative disc disease commonly occurs with age, as discs become more brittle, less resilient and more prone to herniation. Degenerative disc disease is the single most common diagnosis related to serious back and neck pain. When a disc herniates in the spine, the surgeon can sometimes simply remove a portion of the disc. In other cases, where the disc is more damaged and must be removed, something must be placed into the disc space. Otherwise, the two vertebrae will collapse on top of one another, placing pressure on the nerve roots that branch off from the spinal cord.