The last eight months have been very tough for me; having witnessed my father go through a traumatising pain – he suffered from a herniated disc in his cervical spine.

During the last few months, I have come to realise how common this problem is for many people globally and that the solutions that are available today are a credit to the modern world we live in and all the treatments that can now be provided.

I realise the importance of the central nervous system and the spinal chord, and the potential consequences if it is damaged.

The human body is held upright due to the skeleton, and most importantly the spinal cord. The spine itself is divided into four main sections, cervical, thoracic, lumbar and sacral spine.

Each division holds discs, which vary in number, and its purpose is to act as shock absorbers. If any of the discs bulge out of its place, it may compress a nerve root. As a result, this person may experience extreme pain radiating from their back and either their legs or arms.

What is the job of your spinal discs?

Its main job is to act as shock absorbers in between the vertebrae when there is an impact. They also protect the nerves running down the spine. In terms of its structure, it has a tough outer part called the annulus fibrosis. It also has a jelly-like substance inside it, called the nucleus pulposus.

What causes herniated discs?

Sometimes when there is a sudden jolt or movement in the body, this may cause the vertebrae to forcefully compress the disc that is in between it, beyond its limits.

As a result, the disc protrudes, causing wear and tear to your annulus fibrosus (outer layer of disc). Over time, this disc may then weaken the outer annulus fibrosus, and so changes its shape.

As well as that, the nucleus pulposus (jelly-like substance) may eventually dry out and the disc may lose flexibility. As the disc degenerates, the nucleus pulposus pushes the annulus fibrosus outwards resulting in a disc bulge.

 

Effects of herniated disc

Depending on the location of the bulge, the disc may push on or compress, the spinal chord, spinal nerves, or cauda equine, which is a collection of spinal nerve roots at the end of the spinal chord.
If the disc bulges backwards, it bulges the spinal canal. Lateral (sideways) disc bulges compress the spinal nerve roots. Severe disc bulges may cause tears on the annulus fibrosus. Pressure from the vertebrae pushes the nucleus polposus out of the torn annulus causing a disc herniation.

This can impinge upon nerves causing the symptom of pain, numbness, and weakness due to nerve compression. These effects can be felt on your legs as well as your arms, depending on the level of the spine, (cervical, thoracic or lumbar spine), the disc herniation happened.

What are the treatments?

There are many ‘solutions’ to this pain ranging from conservative treatments such as physiotherapy to taking painkilling anti-inflammatory injections and having surgical intervention as a last resort.

Many people suffering from this problem may opt to take an epidural steroid injection, which is often referred to as a nerve block injection. According to this source, Local anaesthetics are first given to the patients.

Then the steroid injection is placed into the epidural space of the spinal column, under fluoroscopic (X-ray) guidance.

It is a short procedure, taking less than an hour, and the expected results are mostly positive.

This source also mentions the importance of using a contrast medium, in order to confirm the needle position and hence delivering the painkiller at the most accurate site.

Also, a patient recalls how he felt after this injection, since the beginning of his pain in 2010. David Francis had a double herniated disc, at two levels, and his pain was “kept in check with epidural steroid injections several times a year”.

Another form of treatment for this painful problem is to have surgical intervention.

There are two variations, one is called cervical disc arthroplasty and the other is called spinal fusion.

According to the third source being used, have one thing in common, they decompress the ‘pinched nerve’.

The nerve that was being irritated due to the disc bulging on it, has been relieved from its compressed state, due to these operations.

Artificial disc ( disc arthroplasty)

According to the third source, the purpose of having this surgery done is to retain motion in the level of the spine the faulty disc is present.

This is maintained with the use of a “prosthetic implant” otherwise known as an artificial disc, often made of metal.

Either neurosurgeons or orthopaedic surgeons often conduct it.

They make an incision on your body, on the upper spine, and search for the painful disc.

Thereafter, the whole of the disc at that level is removed, and an artificial disc fills the hole left behind.

As a result, there will be no content in that level which would be pressing on a nerve and therefore not compressing the nerve, and as a result, the purpose has been fulfilled as the nerve has been decompressed.

An advantage is that this is a new advancement in the medical field and it also allows a patient to freely move their spine, in spite of an artificial disc being present not a natural one.

However, the fact that it is a rather new advancement means that there are no long-term ideas of whether the artificial disc will wear and tear or get damaged.

Spinal fusion

This is often referred to as the traditional method to treat herniated disc problems. It involves forming a “direct only connection between the vertebrae surrounding the painful disc”.

Once the incision is made, either anterior (from the front of the spine) or posterior (from the back of the spine), the disc causing the problem is removed.

Thereafter, the space left is then fused together by the vertebrae above and below the disc space often by providing internal structural support such as a bone graft being used.

The advantage of this method is that it has long-term success stories, and is widely practised globally. Another advantage is that the nerve is decompressed, and therefore there should be very minimal/no pain radiating down the leg or arms. However, there are two main limitations.

One limitation is that this method prevents the movement of the spine at that level where it is being operated on. Another limitation is that bone grafts are traditionally used to support the fusing of the two vertebrae, and more often or not this is “harvested” ( according to the third source) by the patient themselves.

Lastly, as with any spinal operations, the complications are wide. There are many complications such as paralysis, permanent nerve damage as well as the creation of bacteria inside the body due to the presence of a metal being inserted inside the body.

To conclude, humans need the spinal chord in order to stand upright and carry out day to day activities. It is the site where most of our nerves extend from too, hence co-ordination of the body apart is orientated around the spine too.

The spine has a jelly-like substance called a spinal disc which acts as shock absorbers and is embedded in between the vertebrae.

Due to factors that were discussed in this article, the disc can bulge out of place and hence put pressure on the nerves in the spine as well as the spine itself. As a result, the nerve(s) become compressed, and a person has a lot of pain radiating down their legs or arms.

The ultimate treatment is a surgical intervention where either your disc is removed, and the vertebrae above and below it are fused together.

The disc causing the pain is removed and an artificial disc is placed in between the vertebrae, which allows fully functioning motion of the spine at that level. Both methods decompress the nerve, and hence reduce the shooting pain down their spine to their legs or arms.

By Sadiq R, GCSE Biology Tutor. To work with Sadiq or to see if we are a good fit, contact us today.