Intervertebral Discs





A healthy spine is made up of a series of vertebra (bones) separated by a cushion material called intervertebral Discs. These Discs absorb shock and allow movement between the joints of the vertebra.




Degenerative Discs

In a normal and healthy back the discs are well hydrated and able to respond to the pressure of weight and bending. It would be nice if these discs would always stay in such good condition. But, alas they do not. One of the first things they do is begin to dehydrate and thin out from the constant use they get. Though this thinning is normal (and can be expected to be seen in the average 25 year old), physicians give it the up lifting name of Degenerative Disc Disease. Now if you want a diagnosis that leaves you hopeless - here is one. It not only implies that are your discs are degenerating, but that you also have a disease of degeneration. It sounds terrible and I have met many patients that have basically given up on their backs because of this diagnosis. Yes, in some cases the progress of degeneration is exceptional, but in most cases it is just as normal as it is in the average person without back pain. So, this is the case when you don't want to buy into the diagnosis hook, line and sinker. GET A SECOND OPINION!




Bulging Discs

Another situation that discs display when under constant load is they bulge out. In some cases this protrusion can press on a spinal nerves and cause a variety of symptoms, such as pain, numbness, tingling, etc. If the nerve is compressed (impinged, pinched, etc.) physical therapy is often useful and required to remedy the situation. Prolonged nerve impingement can lead to irreversible damage, so always get a definitive diagnosis.

However, there are many times that a bulging disc has no effect on the nerve at all. The disc is bulging, but is not pressing on any of the nerves near by. Many people that experience no pain what so ever have bulging disc. So, if you get a diagnosis of a bulging disc, and your physician recommends immediate surgery, GET A SECOND OPINION! It may be that your surgeon only has one tool, a knife. Or it may be that he has a boat he needs to pay for. Whatever the case always start with the least invasive therapy first.




Ruptured Discs

The last case scenario is referred to a ruptured disc. In this case the outer shell of the disc has torn, broken or burst and the inner nucleus of the disc has escaped into the surrounding tissue. As with a bulging disc, if the material is compressing any of the local nerves that exit the spine, it can cause all types of problems. But again, don't be too fast to assume that the rupture is the direct cause of the pain. Strained muscles and ligaments can produce very similar pain intensity and patterns as a ruptured disc. As before, always seek the least invasive therapy first.




Exceptions

Pain is not a sure fire test to determine if you need surgery or not. However, if you experience loss of function such as the inability to lift your leg or loss of bladder control should you should seek immediate medical attention. In all cases, use your common sense.

Slipped Disc

The term slipped disc is just that, a term. It is a generalized and scary image that your disc has shifted out of place. Basically this does not happen. But, it is still a frequently used term and can refer to any of the above conditions.

For a very nice animated view of discs and disc injuries follow this link: Animated Disc

Other Disc problems include annular tears, which I will go into later.



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