Disc Problems
Problems involving the intervertebral disc can be very painful and difficult to address. A disc problem can occur anywhere in the spine but is most common in the lower back. Disc problems are less frequent in the neck but remain fairly common. Disc problems in the mid back are rare. The intervertebral disc is comprised of two parts. A gel like core surrounded by a fibrous ring. Disc problems occur when there is a tear in the fibrous ring allowing the gel center to push outward. This causes a bulge of the disc which usually backward or backward and slightly sideways. This bulge moves into the spinal canal where the spinal cord and nerve roots travel. If the bulge is large enough it will touch the cord or nerve root and irritate them. This irritation produces pain which travels along the nerve root. The pain will travel into the buttocks or leg if the nerve root is from the low back and to the shoulder region or down the arm if the nerve root is from the neck. If the tear in the fibrous tissue is larger and the gelatinous center moves outside the fibers it is a herniation. These can be large enough to compress the cord or nerve roots. When a nerve root is compressed it will still cause pain or numbness but can also affect the strength of the muscles that it supplies and cause a diminishment of a deep tendon reflex. Compression of the spinal cord can cause weakness, changes of bowel or bladder function and other symptoms. If the part of the gelatinous center of the disc moves into the spinal canal it is called a prolapsed disc or an extruded mass. These can also cause compression of the cord or nerve roots. Intervertebral disc problems can be painful and debilitating. When a problem with the intervertebral disc is suspected advanced imaging is used to better evaluate the presence or extent of the problem. Treatment ranges from the most conservative approach to surgery if other treatments fail.
Disc Injuries
Injuries to the intervertebral disc often present as a sudden onset of pain in the low back or neck with pain shooting into the arm or leg. The onset of symptoms can also be slower with pain or numbness into the arm or leg. The triggering event is often described as minor, just reaching into the trunk of a car or lifting a light weight. The mechanism of injury is a compression force on the disc which causes the gelatinous core to push outward bulging the disc or rupturing outside the fibrous exterior of the disc. Quite often there has been previous injury to the fibrous portion of the disc or degenerative changes have weakened the disc. Degenerative changes are "wear and tear". These come from previous trauma, work, sports or just everyday activities over the course of life. We all get degenerative changes. It is just a matter of how early they will occur. There are disc injuries which happen to otherwise healthy discs. These injuries occur with larger forces such as heavy lifting or a sudden unexpected load placed on the back or neck. Auto accidents or falls are a common source of injuries to the disc. Treatment
Treatment of injuries to the disc varies with the extent of injury and the individual being treated. The most conservative methods of treatment are employed first. These include Chiropractic services, electrical muscle stimulation, traction, manual muscle therapy, stretching, specific exercises and heat or ice application. Home treatment including rest, avoidance of irritating activities and ice applications are used. If satisfactory results are not achieved a course of physical therapy is often the next step. Treatment options become increasingly more aggressive and invasive. Steroid injections to decrease inflammation or oral steroid administration is often tried. Epidural steroid injections, a procedure in which a needle is inserted into the epidural space around the spinal cord and steroids are injected is often used as a last attempt at avoiding surgery. The most common surgical procedure is to remove the lamina which is part of the bone surrounding the spinal canal and use this space as a point of entry to remove the disc. Spacers are inserted in between the vertebral bodies and a titanium cage is connected with screws to vertebra above and the one below to fuse the two together. In the cervical spine entry is typically from the front eliminating the need to remove the lamina. It is a goal in treating disc problems to avoid surgery. General practitioners, Physical Therapists, Chiropractors, Orthopedic Surgeons and Neurosurgeons all work either independently or in cooperation to avoid surgical intervention. |
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Outcome
The successful treatment of disc problems can range from fairly straight forward to major surgery. It is the objective to return to preinjury lifestyle. All treatments except surgery will not remove or return the disc back into it's normal boundaries. This residual protrusion will continue to occupy space and make flare ups possible. A disc injury is actually managed following completion of initial treatment. This management involves lifestyle adjustments of varying degrees depending on the individual case. A program of flexibility and stabilizing exercises is one of the most successful approaches to maintaining a full lifestyle. Alterations of work and home activities to decrease the stress placed on the spine is helpful. Maintaining a healthy weight to reduce stress on the spine is more important after this type of injury. Regular Chiropractic care to maintain motion in the spine is important to keep the body functioning at it's best. We consult with our patients to develop an approach to achieve the fullest lifestyle possible following a disc problem.
The successful treatment of disc problems can range from fairly straight forward to major surgery. It is the objective to return to preinjury lifestyle. All treatments except surgery will not remove or return the disc back into it's normal boundaries. This residual protrusion will continue to occupy space and make flare ups possible. A disc injury is actually managed following completion of initial treatment. This management involves lifestyle adjustments of varying degrees depending on the individual case. A program of flexibility and stabilizing exercises is one of the most successful approaches to maintaining a full lifestyle. Alterations of work and home activities to decrease the stress placed on the spine is helpful. Maintaining a healthy weight to reduce stress on the spine is more important after this type of injury. Regular Chiropractic care to maintain motion in the spine is important to keep the body functioning at it's best. We consult with our patients to develop an approach to achieve the fullest lifestyle possible following a disc problem.