By: Steve Siwy for Back1One of the most common injuries to the back, according to the American Association of Neurological Surgeons, is a herniated or “slipped” disc.” About a quarter of all back pain is the result of a herniated disc, which is a condition wherein the soft nucleus of the spinal disc pokes though a tear in the disc’s outside wall, or annulus, and places pressure on the nerves in the spine. “The disks are the pads between the spinal bones that cushion the bones and let your spine flex in different directions,” explained Dr. Steven Atlas of Harvard Medical School to ABC News. “There can be a tear in the ligament that keeps that disk in place; you can think of it like jelly from a jelly doughnut squirting out if there's a tear in the side.”.
Treatment for herniated discs, and indeed any back pain, usually begins with a recommendation of bed rest and over-the-counter analgesics, sometimes supplemented with muscle relaxers or non-steroidal anti-inflammatory medications (NSAIDs, such as ibuprofen or naproxen). Gentle heat can also be applied to the affected area, and physical therapy is often recommended. If a patient’s back pain isn’t alleviated satisfactorily by conservative treatments, his doctor may recommend spinal injections, or even surgery.
Spinal injections are employed to various ends. A doctor may wish to reduce inflammation and relieve pain with an injection of steroids, or to numb certain areas of the back to pinpoint the source of the pain. In some cases, the enzyme chymopapain may be injected to dissolve the portions of the disc pressing against the nerve roots.
If surgery is called for, the doctor may recommend an open discectomy or spinal fusion. Open discectomy is surgery to excise a portion of the disc and relieve pressure on the nerves. To reach the disc itself, the doctor must make an incision over the spine and remove some of the ligament and bone (a procedure called a laminectomy or laminotomy), which exposes the disc so that the doctor can remove a portion of it. Less invasive open discectomies can now also be performed using miniature arthroscopic tools through a smaller incision, though the method described above is more common.
Spinal fusion surgery fastens two or more vertebrae together to prevent them from moving against each other. The vertebrae are held immobile for the procedure, and small bone grafts are placed between them so that they heal into a single piece. The pieces of bone used for the grafts can come either from the patient (autogenous bone) or from another individual, via a bone bank (allograft bone). According to the AAOS, autogenous bone is better for promoting fusion, but has the disadvantage of requiring extra surgery to harvest it from another location on the patient’s body (often the hip or pelvis).
Recently, doctors in Europe have begun to use artificial implants to replace herniated discs. As of 2002, according to the North American Spine Society, over 4,500 disc replacement surgeries had already been performed in Europe. Researchers in the U.S. continue to collect data on the safety of various disc replacements (which include entire prosthetic discs, as well as artificial nuclei that replace only the disc’s soft center) prior to FDA approval.
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