What is a disc?
The spinal column consists of bones called vertebral bodies (33 in number). Between the vertebral bodies lies the disc. These discs are like rubber washers and allow movement of the spinal column. The disc contains nucleus pulposis (jelly-like material) surrounded by a annulus fibrosis (fibrous ring).
What is a Disc Prolapse?
When the annulus becomes diseased (weakened) due to injury or any other condition then the nucleus pulposis herniates out or prolapses into the spinal canal. This condition is called disc prolapse. The prolapsed disc material may compress on the spinal cord and its accompanying nerve roots.
What are the symptoms?
The prolapsed disc can press on the spinal cord and its nerve roots. Most commonly it compresses a single nerve root leading to pain, numbness and weakness in the upper limb (arm, forearm and hand). If the prolapse is central and presses on the spinal cord it can lead to weakness of both lower limbs and may also affect the control of bowel and urinary bladder.
How is it diagnosed?
Usually the symptoms of a patient who presents with, neck pain radiating to the arm, fore-arm and hand with or without weakness / numbness are enough to help the doctor identify the problem. Clinical examination will help to further narrow down the diagnosis to the level of disc prolapse.
However, other diseases of the spine like infection, tumour and fracture can also present with similar symptoms.
To rule out other conditions, various blood tests, X-rays, CT scan or MRI scans are advised.
What is the treatment?
Almost 85-90% of patients who get disc prolapse will resolve with medical treatment. This includes rest, analgesics and anti-inflammatory medication (pain relief) and physiotherapy (cervical traction, heat therapy). Short course of steroids (strong anti-inflammatory) may be helpful in an acute disc prolapse.
Rest is advised for only 3-4 days. Once the acute pain has subsided a course of assisted physiotherapy is required.
If the symptoms do not resolve after 4- 6 weeks of treatment or if any nerve or spinal cord related symptoms increase like numbness, weakness or loss of bowel and bladder control, then immediate surgery may be required.
What are the surgical options available?
The goal of surgery is to decompress (remove the pressure) the nerve root. There are many surgical options available.
- Cervical micro-discectomy and fusion
- Disc replacement
- Posterior foraminotomy and disc excision
What is cervical micro-discectomy and fusion?
Through a small incision on the front of the neck (see figure 1), the spine is accessed. Under microscope visualization the disc material compressing the nerve is removed. This relieves the pain and allows the nerve to regain its normal function. The empty disc space is filled with bone graft to achieve fusion (joining) between the vertebrae. Occasionally the vertebrae may be fixed using a plate (see figure).
 
Figure 1 Figure 2
What is a Disc replacement?
The procedure is similar to a joint replacement in the hip or knee. The diseased disc is replaced by an artificial disc. It preserves the motion between the adjacent vertebrae.
As in a cervical miro-discectomy the disc material compressing the nerve root is removed. Instead of fusing the vertebrae with bone an artificial disc is placed in the disc space.
The major advantage of this procedure is that it preserves motion and in comparison to fusion, motion preservation decreases the chances of degeneration at the disc level above and below the diseased level
Our hospital is one of the few centres in the country doing this specialised procedure.
 
Bone model with disc replacement X-ray of a patient with disc replacement
What is a Posterior foraminotomy and disc excision?
This procedure is done occasionally in an acute isolated disc prolapse and offers no benefit over a cervical micro-discectomy. Through an incision in the back of the neck, the disc compressing on the nerve root is excised (removed), thus relieving pain.
This information is provided by Ganga hospital and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the hospital (0422-2485000) to book an appointment to see a doctor. This document was last reviewed on: 1/05/2008
|
