The Spine, Disc Disease and Treatment
The spine is made up of a series of bones called vertebrae, stacked on top of each other, running from your neck to your lower back. Between these vertebrae are what we call discs, which act as a cushion for the vertebrae.
What happens when discs degenerate?
The discs in the spine can be damaged as a result of traumatic injury, which results in a herniation (a bulge or rupture) of the disc. This is typically marked by a sudden onset of pain, which can start in the neck and radiate down the arm, or pain in the back that can radiate down the leg. More commonly, though, what we see is chronic degeneration. This can result from normal aging or overuse, and pain will typically increase over time.
As a disc continues to degenerate, the space between the bones narrows, causing pain in the back or neck. That loss of space also results in less space for the nerves that go to the arms and legs, which can cause that radiating pain to the arm or leg as the nerves are compressed.
Treating damaged discs
Normally most spine providers will recommend conservative treatment first. Non-surgical treatments can be very effective to treat the pain associated with this condition. The initial treatment options include:
- medications such as anti-inflammatories
- physical therapy to work on exercise that can address some of the pain and restore function
- activity modification
- weight loss, especially in chronic degenerative conditions
- cervical traction, which is a device that can gently pull in line with the neck to take some pressure off the nerves
If pain cannot be managed through those treatment options, more invasive treatments may be appropriate. Steroid injections that target the area of pain or the nerve that is being compressed can also be considered. These injections can decrease the local inflammation around the nerve that is being compressed.
When all other treatments have failed, there are surgical treatments that can address the issue. The type of surgery varies from patient to patient and also by the location of the issue (neck versus back), but treatment options include removing the disc, replacing the disc, or performing a fusion.
Great advances have been made in treating spine disease in recent years. We now have the technology to replace discs when they have become damaged. Through this procedure, the surgeon can remove the damaged disc material, especially in the areas where it is putting pressure on the nerves. An artificial disc implant can then be used to fill the space where the previous disc was removed. This implant can mimic the role and the motion of the normal disc and help keep the pressure off the nerves.
Disc replacements can be an approach to treating pain and disc degeneration for some individuals, but not everyone is a candidate for this procedure.
Fusion is another type of procedure. For some patients, the degenerative changes in the spine may be so severe that disk replacement is not an option. Other patients may have instability between the bones, so preserving the normal motion is not an option. These patients may be candidates for fusion, a procedure that allows the bones to grow together across the disc space. The idea is that by stopping the motion and getting the bones to grow together, we can eliminate some of that pain that occurs with the motion. Fusion can also be helpful if there are several locations within the spine that have degenerated.
What to expect after a disc replacement procedure
A routine disc replacement may sometimes be done as an outpatient procedure, or it may involve an overnight stay in the hospital. Patients are permitted to walk right after surgery and gradually resume activity. They should avoid excessive bending, lifting, or twisting in the initial postoperative period.
Preventing disc damage
Like so many aspects of our health, both genetics and lifestyle play a role in disc disease. Some people are predisposed to develop degenerative changes in their neck and back. Lifestyle factors and overuse can also accelerate the degenerative process. But there are modifications you can make to help keep your discs as healthy as they can be:
- maintain good posture
- exercise regularly
- maintain a healthy weight to prevent excessive stress on the discs
About the Author:
Eren O. Kuris, MD
Eren O. Kuris, MD is a spine surgeon with the Lifespan Orthopedic Institute. Dr. Kuris specializes in orthopedic spine surgery. He is also an assistant professor of orthopedics at The Warren Alpert Medical School of Brown University, and the director of spine trauma, tumor, and infection within the department of orthopedic surgery.
Dr. Kuris received his medical degree from Tulane University, New Orleans. He completed his orthopedic surgery residency at The Warren Alpert Medical School of Brown University. He went on to complete a fellowship in orthopedic trauma also at the Alpert Medical School. Dr. Kuris completed a sub-specialty fellowship in spine from the University of Colorado School of Medicine.
Dr. Kuris is an active member of the Orthopaedic Trauma Association, North American Spine Society, American Orthopaedic Association Emerging Leaders, and American Academy of Orthopaedic Surgeon. He also serves on various committees for these organizations.
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