A common reason patients present with spinal pain is due to a disc problem. Disc terminology varies widely, and even among medical professionals, it may be hard to find a consensus. We have all heard the term “slipped disc”. A more accurate way of describing disc pathology is to refer to either a herniated disc or a bulging disc.
A bulge means that the annular fibers that wrap around the disc and hold it together have some tears and weakness. This will allow the jelly-like center of the disc to flow toward that weak area and push against it causing an asymmetric ballooning of the exterior fibers. This bulging can be in any direction and may actually put pressure against the sensitive spinal nerve roots as they exit your spinal canal. This is turn may cause leg or arm pain, numbness, or even weakness and loss of muscle tone.
A true disc herniation means that the annular fibers have actually ripped apart and some of the fluid center of the disc has leaked out into either the canal or the intervertebral foramen, and is again putting pressure on the nerve root or even the spinal cord itself.
If a disc lesion is suspected, the first step is appropriate imaging to determine the extent of the problem. Plain film radiographs, or x-rays, are still frequently utilized as an initial screen. They are cost effective and do provide valuable information. Unfortunately, plain films are excellent for evaluating boney structures, but they will not show the soft tissue that makes up a disc.
MRI and CT scans are two of the best ways to determine actual disc involvement. These imaging modalities will usually offer a clear view of the area in question. Occasionally a discogram may also need to be done. This is when a radioactive dye is injected into the disc while an MRI is being preformed in order to visualize the state of the disc.
Spinal stenosis is another cause of back and neck pain. Stenosis is defined as a narrowing in the spinal canal. The spinal canal is the space between the vertebra that wraps around and protects the spinal cord. Stenosis usually occurs when the discs start to degenerate and cause the formation of bone spurs that can encroach on the cord. A MRI or CT study is necessary to determine the extent of boney extrusion into the canal.
Spinal disc surgery is usually viewed as a last resort after conservative methods fail. Many patients experience relief from chiropractic care or physical therapy. Other treatments may include epidural injections, non-steroidal anti-inflammatory drugs or oral steroids. Sometimes a combination of several different kinds of therapies in conjunction work very well to relive pain and improve function.
Pain that is sever and debilitating, or continues without improvement for more than six weeks will probably need surgical intervention. Advances in surgical techniques have made these procedures much more successful and much safer. Many operations are now preformed as same day surgeries eliminating any hospital stays.
Make sure you ask your doctor a lot of questions. It is your spine.
