Degenerative Disc Disease
Discs are soft, gelatin-like pads located between the hard bones or vertebrae that make up the spinal column, which encases the spinal cord and nerves. Discs function as shock absorbers when you flex, rotate, or bend your back or neck, and they begin to degenerate as we age. The gel-like substance called the nucleus may thin to the point where there is insufficient padding between verterbrae. Another common spinal condition is herniated nucleus pulposus, often referred to as a “ruptured” or “slipped” disc. It occurs when the cartilage shock absorber between the bones of the spine spills over into the spinal canal, causing compression of one of the spinal nerves. It may be caused by trauma, stress to the area or degenerative changes over time. In general, disc herniation symptoms will intensity with coughing, sneezing, or sitting.
A cervical or neck disc herniation may cause pain, tingling, numbness, weakness in the neck, arms or hands. A lumbar disc herniation in the lower back may send pain shooting plain into the buttocks or down the leg, local severe back pain, burning in the back, weakness in one leg, changes in bowel or bladder activity, and lack of sensation or pins-and-needles tingling in one leg. Thoracic disc herniations, which affect the upper spine are less common than cervical or lumbar disc herniations, and often discovered as a secondary diagnosis. Often asymptomatic, they are tricky to diagnose and could be a ticking time bomb if the herniation progresses to compress the spinal cord itself.
Surgical treatment includes a microdiscectomy, a minimally invasive procedure, to remove the disc. Another option is implanting an artificial disc, made of metal and plastic, to maintain mobility of the spine. It is most commonly used in lumbar spinal surgery, but your neurosurgeon will weigh the benefits of implanting an artificial disc against performing spinal fusion. Recently, cervical disc replacement has emerged as a surgical technique to maintain neck mobility.
In older patients, spondylolysis is caused by degeneration of the joints and discs in a part of the vertebrae known as the pars, usually involving the fourth or the fifth lumbar vertebra in the lower back. Sometimes, spondylolysis may allow the vertebral bones to slip, throwing the spine out of alignment. In extreme cases, this may lead to spondylolisthesis, which may result in severe localized pain in the back as well as pain in the legs. This is slippage of one vertebra relative to another. In young people, spondylolysis may be a result of a stress fracture most commonly seen in active athletes, such as gymnasts, weightlifters, football players and dancers. It can be congenital or be caused by trauma.
Patients with spondylolysis may feel slight to severe back pain, particularly across the lower back, muscle spasms, back stiffness, tightening of the hamstrings, nerve compression, and changes in posture.
Treatment options include rest, physical therapy, medication, chiropractic care, steroid injections or surgery, such as discectomy, laminectomy or spinal fusion. Cardiovascular exercise, maintaining a healthy weight and a regimen to improve strength and flexibility in the area of herniation may help relieve symptoms and prevent muscle spasms in the future. There are several different artificial discs on the market, made of various materials. They have been utilized in lumbar spine surgery and cervical spine surgery.