Are steroids given for degenerated
disc problems?
Steroids applied locally by injection can be very helpful
if properly given to selected patients and generally post
few dangers. These injections should be given by an experienced
pain specialist or radiologist. They may be most effective
in the setting of spinal stenosis or nerve root irritation
due to disc degeneration. Steroids given orally in the form
of pills (such as Prednisone ) may have significant side
affects on various organ systems including the bones (osteoporosis,
avascular necrosis…) that can exceed the potential
medical benefits. One must realize that a mildly bulging,
or "dried out" disc is rarely a severe problem.
Disc changes are a normal part of aging in the spine. When
discs are found to lose water content, it means they are
losing some of their ability to act as a shock absorber
and the function of properly binding the vertebrae. This
can lead to a very subtle instability that may be responsible
for pain in some people. If the pain is not severe when
a person is in bed or at rest but becomes severe with walking,
moving about or prolonged sitting, then there is most likely
a mechanical component to the pain. In that case it may
be very beneficial to work on stabilizing the spine by developing
the muscular supports. Steroid injections may not be the
best approach in such cases. Good results can be achieved
with a combination of bracing and upper extremity exercises.
Locally injected steroids into the facet joints of the spine
may offer temporary anti-inflammatory action that can offer
some pain relief. However, the primary focus of treatment
in most cases is directed towards a guided exercise program.
If your questions are not answered here please feel free
to contact us.
When does one consider surgery for
a herniated disc in the cervical spine ?
The spinal canal which contains the spinal cord has only
limited space available within the limits of the bones and
ligaments of the cervical spine. When a disc bulges inside
the canal and leads to a large herniation then a compression
of nerves or spinal cord can develop which leads to abnormal
function of the nerves or pain. In many cases the herniated
disc may shrink, or the nerves become "adjusted" to
the herniation and the symptoms may resolve with time. When
symptoms are severe or do not improve with time, then surgery
may be necessary. Surgical treatment usually involves a
decompression performed by an anterior disc removal followed
by interbody fusion (fusion means causing two vertebrae
to grow together into a solid block by inserting a bone
graft at the place where the disc was removed). In some
cases a decompression can be accomplished by a posterior
laminectomy and disc resection without fusion.
If your questions are not answered here please feel free
to contact us.
What is a ruptured disc?
The disc is a complex structure that carries two principal
functions: bind two vertebra solidly together (while permitting
some motion) and providing a shock absorbing function. The
disc is located between two vertebra and looks like a very
solid ligament made of multiple outer fibrous layers (called
the 'annulus' which means "ring") while containing
a jelly-like substance in the middle (called the 'nucleus').
A ruptured disc means that an unusual and excessive load
was applied (usual by high velocity) on a disc resulting
in the rupture of all or most of the layers of the annulus.
The consequence is a disruption of the binding ligament
and leakage of the jelly (nucleus pulposus) out of the boundaries
of the annulus. As a consequence the two vertebrae connected
by the disc which suffered the injury are no longer smoothly
bound together and a combination of instability and nerve
irritation can lead to severe back pain which does not respond
to conservative treatment. When conservative treatment fails,
the appropriate treatment for this condition is not a laminectomy
with discectomy (even when there is an image which may suggest
a herniated disc) but rather a stabilization by interboby
fusion.
If your questions are not answered here please feel free
to contact us.
What is the difference between a
slipped, herniated and bulging disc?
The word "slipped " means that a disc has lost
its integrity and that a portion of the disc has passed
beyond the normal anatomical boundaries. A herniated disc
is the same thing as a 'slipped disc'. When a disc fragment
bulges beyond its normal position nerve irritation may occur
which is often call a "pinched nerve" or sciatica.
Symptoms of leg or foot pain and numbness, tingling or shooting
electrical type feelings may occur. Varying degrees of disc
herniation may occur ranging from " bulge" (which
is usually not serious) to "large herniation" or "extrusion".
It is often not clear what causes a disc to herniate. The
application of unusual loads may compress the disc in such
a way that part of the jelly (nucleus) gets out of the boundaries
of the annulus and is partially or totally extruded backward,
where the ligaments are weakest. The disc fragments may
get stuck in the spinal canal. The canal can not expand
and the presence of the disc fragment takes up the space
of the nerves thus leading to compression of one or several
nerve roots. This leads to pain following the nerve root
distribution and can go to the hip, the knee, the calf or
the ankle and the foot. Any disc herniation requires a complete
evaluation by a spine specialist. If there are no severe
neurological symptoms (weakness, abnormal reflex…)
conservative management is likely to be successful. Surgical
treatment is only considered in rare cases of intractable
excruciating pain, which does not improve, and/or severe
neurological symptoms.
If your questions are not answered here please feel free
to contact us.
When does a herniated disc require
surgery?
It is rare that a herniated disc must be removed surgically.
In most instances of disc herniation symptoms gradually
resolve without surgical treatment. In the few cases of
severe persistent symptoms and progressive neurologic impairment,
an operation may be required. One of the few reasons for
an immediate removal of a disc is when the disc compresses
the nerves which are responsible for bladder and bowel control
(cauda equina syndrome). Any loss of bladder control or
changes in bowel or bladder habits should be evaluated immediately
by a specialist.
If your questions are not answered here please feel free
to contact us.
What are the results for disc surgery?
In those few patients who require surgery for a herniated
or extruded intervertebral disc, the results of surgery
are very good. The results in various studies are variable
but over 90% of patients can be expected to get relief from
their symptoms. It is essential to have proper pre-operative
evaluation by a spine surgeon, which includes an MRI and
occasionally a CT-myelogram. Careful selection of patients
who truly require surgery is essential.
If your questions are not answered here please feel free
to contact us.
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