Have you ever had an x-ray and noticed an empty black space between each vertebra throughout the spine? Don’t worry, it’s not empty spaces. That is where each disc resides at each level. The intervertebral disc plays an extremely crucial role in movement and spine protection. Unfortunately, the disc can become damaged, leaving individuals with unbearable pain and discomfort. In this week’s blog, we will discuss the anatomy of the disc, their function, the different types of disc damage, and what can be done for treatment.
Anatomy and Function of the Disc
Each intervertebral disc in the cervical, thoracic and lumbar spine consists of three parts: cartilaginous endplates, annulus fibrosus and nucleus pulposus.
- Cartilaginous Endplates- The endplates have two major functions: mechanical movement and nutrient supply. The endplates are driven between two vertebrae and allow for slight movement, stability and protection. The endplates are the only part of the disc that provides blood supply which provides the disc with nutrients.
- Annulus Fibrosus- Made up of collagen and proteins, the annulus fibrosus is the outer layer of the disc that allows for rotating forces of the spine and also holds up each vertebra between each other. Another function is that it is the protective casing for what is inside, the nucleus pulposus.
- Nucleus Pulposus- The nucleus is like a jelly-filled donut, consisting of a soft, gelatinous center that allows for shock absorption during movement.
Each part of a disc has its own unique function and are all essential for movement, but the absolute main function of the disc is shock absorption during movement. The purpose of shock absorption is to reduce stress and pressure when movement occurs. Imagine what it would be like if these shock absorbers were damaged or completely gone.
Different Types of Disc Damage
Herniated/bulging disc, pinched nerves, sciatica, spinal stenosis, degenerative disc disease, etc. are all disc and nerve root issues. Over the following weeks, we will talk about all of these conditions, but for this week, we will talk directly about different disc damage how each is different.
When there is damage to a disc, patients can be left with severe symptoms such as pain, numbness/tingling down extremities, loss of sensation, muscle weakness and even impaired organ function. Most commonly, disc are damaged by repetitive forces that cause stress to the disc. This can be from the nature of someone’s job such as a construction worker, firefighter, competitive weightlifter, etc. It could have happened to an average Joe who was raking leaves or shoveling snow. It could have even happened from something as simple as a cough or sneeze. In any case, disc damage needs to be identified, addressed and treated to prevent damage from getting worse.
The first thing that needs defined is the difference between a bulging disc and a herniated disc. People think they are the same, but they are not. Bulging disc typically occur before a herniated disc. Some people don’t even know they have a bulging disc because sometimes, it doesn’t produce any pain. By the time some patients start experiencing pain and symptoms, the discs are already in a herniated state.
Here is the biggest difference between a bulging disc and a herniated disc. In a bulging disc, the nucleus pulposus begins to swell and change shape but the contents do not breakthrough the annulus fibrosus. A herniated disc however is when a bulging disc worsens and contents of the nucleus pulposus begins to break through the annulus fibrosus. Once a disc is herniated, if treatment has not been performed, the disc can continue to deteriorate and create further symptoms. There are four stages that lead to disc herniation that we will briefly discuss.
Stages 1 & 2: Disc Protrusion & Disc Prolapse
A disc protrusion and disc prolapse are considered disc bulges. The difference between the two is that a protrusion is when the nucleus pulpous first begins to swell and a prolapse is when the nucleus continues to deform but still has not broke through the annulus fibrosus.
Stages 3 & 4: Disc Extrusion & Disc Sequestration
A disc extrusion and disc sequestration are considered types of herniated disc. A disc extrusion is when contents of the nucleus pulposus have broken through the annulus fibrosus and made its way into the spinal canal. A disc sequestration is when fragments of a herniated disc migrate into the epidural space. The epidural space is an area between a piece of connective tissue called the dura mater and the vertebral wall. This space contains, fat, blood vessels and nerves. A disc sequestration is the worst disc injury possible.
How to Treat Disc Injuries
Disc injuries really aren’t all that hard to identify, but a lengthy detailed exam should be performed for a secure confirmation, proper management and treatment. MRIs are the gold standard diagnostic imaging to confirm a disc injury and can actually identify the severity of each disc level. X-rays are good at showing disc thinning and degeneration of the vertebrae, but they will not help identify disc bulging or herniation. Even though an MRI will provide the answer, it’s always good for the doctor to perform an orthopedic examination geared specifically toward the discs.
Once a disc injury is identified, the next steps are finding a treatment that will help eliminate pain. In many cases, patients don’t even know they have a disc bulge because it may not produce any pain or symptoms. Even though a small percentage of individuals experience pain with disc bulges, that doesn’t mean they have to go under the knife. In most cases, these patients are treated conservatively by seeing a massage therapist, physical therapist or chiropractor. Yes, medical doctors may want to give opioids or an injection to numb the pain, but surgery is not typically considered at this point.
Most patients won’t experience pain until a disc has herniated. Then they will get unexplained, sudden severe pain associated with numbness, tingling and sometimes muscle weakness. These are the patients whose medical doctors refer out for a surgical consultation. Here is a fun fact: most patients don’t want to get surgery on their back or neck. So, why do they? Mainly because they think that there is no other choice and it’s the only solution to get out of pain. Here’s another fun fact: spinal surgery is only 20% effective. Are you thinking what we’re thinking? Why spend $30K-$50K out of pocket for a procedure that is more than likely to fail?
Well, we have great news. There is another solution! We discussed it a few blogs back. Non-surgical spinal decompression is FDA and evidence-based approved and has helped millions of people suffering from low back and neck pain regain and live a normal life. It is painless, safe and deemed extremely effective. With hundreds of research studies performed, the decompression table we use, DRX-9000, has a 93% success rate. So, here is the question: Would you rather have a very expensive surgery done with a low success rate, or would you rather use an alternative treatment with a high success rate at an affordable cost? That’s a no brainer, right?
So, as you can see, disc injuries are not something to take lightly. They don’t get any better unless you do something about it. If you or someone you know is tired of living in pain and tried just about anything to do just that, please consider non-surgical spinal decompression. It could be your saving grace. If you have any questions about spinal decompression, please feel free to call us at (724) 547-3377 and checkout our website at www.drlarrywilkinsspinalcare.com for our previous blog on spinal decompression.
Yours In Health,
Larry E. Wilkins, DC
Brian M. Steinert, DC