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 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. Protruded Disc
2. Extruded Disc
3. Sequestered 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.
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.
Only after all other means have been exhausted should surgery be considered as an option.
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