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Spine

What is a degenerative disc?

The bones of the spine, called vertebrae, are separated by fluid filled spacers called vertebral discs. These spinal cushions act to absorb shock from movement. They also provide separation between the discs to allow nerves from the spinal cord to exit to the body. Degenerative discs are the natural aging process of the spine. As the body ages, wear and tear of the discs lead to a decrease in disc height and they are sometimes injured.

What is an intervertebral disc?

The disc is a fluid filled (mostly water) cushion made up of two parts. The outside, called the annulus, is made of cartilage woven together like plywood and the inside, the nucleus, is made up of a gelatin like material. It is sometimes described as being like a 'jelly-filled donut'.

What is a herniated disc?

Sometimes a herniated disc is called a ‘slipped disc.’ This is actually incorrect because the disc doesn’t actually slip, it remains in place but sometimes bulges (bulging disk) or actually breaks open (fully herniated disc). Herniated discs can happen in the neck as well as the low back, and often come with symptoms that radiate down the legs or arms and into the toes and fingers.

Most discs herniate toward the back and lateral side of the annulus. This can make sitting or bending particularly uncomfortable. Very seldom bowel or bladder problems or a progressive weakness in the arms or legs might occur. This requires urgent and immediate medical attention!

How is a herniated determined?

What is spinal stenosis?

The first step is to determine how serious the herniation is, meaning how much does it affect the patient’s life. Most herniated discs will resolve on their own with some conservative treatment (e.g. medication and moderate exercise). Persistent symptoms may require aggressive physical therapy. If all attempts to resolve the symptoms fail, minimally invasive surgical decompression may provide relief.

Surgical indications include: severe and unrelenting pain, progressive neurological symptoms or the development of bowel or bladder problems.

How is a herniated disc treated?

Stenosis is the abnormal narrowing of a passage of the body. In the case of spinal stenosis, it is a narrowing of the spinal canal putting pressure either on the spinal cord or spinal nerves. This can happen from bony spurs that develop or a reduction of disc space, both of which lead to pressure on the cord or nerves. Spinal stenosis is mostly seen in people after the age of 50 with the onset of degenerative disc disease. Sometimes spinal stenosis is congenital (from birth), and small changes in the bony structures of the spine can cause significant problems.

How is spinal stenosis determined?

Patients with spinal stenosis typically complain of leg pain that gets worse with walking. Often patients will get relief by sitting or leaning forward. Spinal stenosis is most often determined through regular X-rays. CT myelograms and MRIs can often help.

How is spinal stenosis treated?

Initial treatment includes medications, steroid injections and possibly narcotic medications. Sometimes physical therapy to strength the back muscles can help. Decompression surgery can also be helpful when other treatments have been tried and failed.

What is a Discectomy?

A discectomy is a surgical procedure that removes a portion of the disc that bulges out and presses on a nerve root causing pain (see herniated disc). The “-ectomy” means “…a cutting out". Indications for this procedure is unrelenting back or leg pain that has not been relieved by non-surgical methods (see Non Operative Treatment).

What is a laminectomy?

Laminectomy means the removal of the bone that covers the back of the spinal canal. This procedure decompresses the spinal cord and nerve roots giving them more room. The lamina is the bone that covers the back of the spinal canal “- ectomy” means “…a cutting out." The surgery may also remove a herniated disc or bony spurs. It is intended to relief pain and other symptoms.

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