Disc Problems

Spinal Disc Problems & Disc Herniations

What are spinal discs?

Spinal discs are a critically important part of your spinal column.  Along with the vertebra (spinal bones), they perform many functions.  The discs provide shock absorption, protection of the spinal cord and they ensure the flexibility of the spine, along with other functions.

The spinal discs attach to the top and bottom of each vertebra.  They have a thick, tough exterior composed of concentric outer rings known as annuli fibrosis surrounding an inner core.  Because they are arranged in an alternating pattern with the vertebrae, annuli fibrosis allow flexibility while preventing the vertebrae from moving too much and causing injury.

Inside each annulus fibrosis is a jelly-like substance called the nucleus pulposus.  It contains some proteins, but is primarily made up of water.  The nucleus provides more shock absorption than the annulus and works to evenly distribute pressure and force imposed on the structure.

What are the most common disc problems?

A disc bulge results from slight tears in the outermost fibers of an annulus fibrosis.  These small tears can be painful for a short time.

A disc protrusion/extrusion, also called a herniation, is a more herniateddisc2.jpg significant injury.  It results from a more substantial or complete tear of the fibers of an annulus causing some of the nucleus to protrude out of the disc. This protrusion usually happens in one distinct area of the disc and not along a large component of the disc. A herniation can be painful and may even cause nerve compression. But many people have bulging or herniated discs that cause no pain at all. In the most severe cases, the spinal cord can become compressed. 
Disc sequestration is the most severe stage of a disc herniation.  This occurs when the gelatinous portion of the disc is not only squeezed out, but also separated from the main part of the disc.

Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from the interior disc material.

The most common disc problem suffered by adults is degenerative disc disease.  At birth, 80 percent of the disc is composed of water. In order for the disc to function properly, it must be well hydrated. Degenerative disc disease occurs when the nucleus loses water and small tears develop in it.  The body then forms osteophytes (bone spurs), along the edges of the vertebra and the disc space narrows.  The most recent evidence shows that, most often, there is a hereditary link to the development of degenerative disc disease.  Degenerative disc disease can also be caused by trauma or injury.

What are the common symptoms of disc problems?

Common symptoms of disc problems include, but are not limited to:
• Back or neck pain
• Leg or arm pain
• Stiffness
• Tenderness of the spine and spinal muscles

How are disc problems diagnosed?
Disc problems are most often diagnosed with a thorough history and physical examination, including examination of your nervous and musculoskeletal systems.  A complete review of symptoms will include the location of the pain, a description of how the pain feels and what, if any, positions or activities make the symptoms better or worse.  A review of any recurring health problems, previous diagnoses, past treatments and surgeries, current medications and the reaction to these medications and treatments is also taken into account.  Physical examination including sensory tests and muscle strength tests will be used to help determine whether the symptoms are being caused by degenerative disc disease, disc herniation or another problem.

Plain film x-rays are only marginally helpful in confirming a disc herniation diagnosis.  Magnetic resonance imaging (MRI) is usually the imaging test of choice.  This test gives doctors specific information about the type of herniation and location along with disc alignment, height, hydration.

How are disc problems treated?

disc_image.jpg In most circumstances, disc problems are easily treated with conservative care.  One of the reasons for a patient's improvement of symptoms associated with herniated discs is the tendency of the body to gradually reabsorb the extruded disc fragment over time.

Getting back to normal activities as quickly and safely as possible is critical.  Typically, the less time a patient spends in bed, the better the long-term results. 
Chiropractic spinal manipulation has also been demonstrated to be a safe and effective tool in the management of disc problems. Manipulation is especially effective when combined with therapeutic exercise.  Early in the course of treatment of a new injury, Dr. Rulli will set a goal to improve the patient's level of functioning, in conjunction with decreasing their symptom and pain levels.  At our office, Dr. Rulli uses different physical modalities or physiotherapies, in addition to spinal manipulation, to reach these goals.

In most circumstances, spinal surgery and injections are not necessary in the management of disc problems.  Dr. Rulli can discuss all available treatment options with a patient to help them decide the best course of action.
Once a patient's condition is more stable, it is important that they follow treatment care directions and perform the home exercises as instructed. 


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