A Spinal disc is a spine condition that occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall, similar to the filling being squeezed out of a jelly doughnut. Neck or arm pain may result when the disc material touches or compresses a nearby spinal nerve. Conservative nonsurgical treatment is the first step to recovery. With a team approach to treatment, over 90% of people improve in about 6 weeks and return to normal activity. If you don’t respond to conservative treatment, your doctor may recommend surgery.
Anatomy of the Spinal disc
To understand a Spinal disc, it is helpful to understand how your spine works. Your spine is made of 24 moveable bones called vertebrae. The cervical (neck) section of the spine supports the weight of your head (approximately 10 pounds) and allows you to bend your head forward and backward, from side to side, and rotate 180 degrees. There are 7 cervical vertebrae numbered C1 to C7. The vertebrae are separated by discs, which act as shock absorbers preventing the vertebrae from rubbing together.
The outer ring of the disc is called the annulus. It has fibrous bands that attach between the bodies of each vertebra. Each disc has a gel-filled center called the nucleus. At each disc level, a pair of spinal nerves exit from the spinal cord and branch out to your body. Your spinal cord and the spinal nerves act as a "telephone," allowing messages, or impulses, to travel back and forth between your brain and body to relay sensation and control movement
What Are The Symptoms?
Symptoms of a Spinal disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated cervical disc, you may feel pain that radiates down your arm and possibly into your hand. You may also feel pain on or near your shoulder blade, and neck pain when turning your head or bending your neck. Sometimes you may have muscle spasms (meaning the muscles tighten uncontrollably). Sometimes the pain is accompanied by numbness and tingling in your arm. You may also have muscle weakness in your biceps, triceps, and handgrip. You may have first noticed pain when you woke up, without any traumatic event that might have caused injury. Some patients find relief by holding their arm in an elevated position behind their head because this position relieves pressure on the nerve.
An Alternative to Traditional Spinal Fusion
Age, genetics and everyday wear-and-tear of routine activities eventually can contribute to damage and degeneration of the discs that cushion the bones of the spine (the vertebrae). To treat degenerative disc disease, doctors usually begin with conservative (nonsurgical) medical treatment. When conservative therapy fails, other approaches, possibly including surgery, may be recommended. Currently, the gold standard for surgical treatment of problematic degenerative disc disease is spinal fusion. This procedure attempts to permanently lock two or more spinal vertebrae together so they cannot move except as a single unit. This may alleviate pain in a motion segment.
Spinal fusion, however, has well known potential disadvantages, including:
- Loss of motion and flexibility
- Permanently altered motion characteristics and biomechanics
- Potential for accelerated degeneration of the discs above and below the fused level that can lead to more pain and the need for more surgery
Artificial disc replacement offers a reversible, viable alternative to fusion that possibly avoids the accepted shortcomings of fusion. By inserting an artificial disc instead of performing spinal fusion, there is the possibility of reducing damage to nearby discs and joints. This is because artificial disc replacement allows for motion preservation, near normal distribution of stress along the spine and restoration of pre-degenerative disc height.
What Are The Causes?
Discs can bulge or herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and become harder. The tough fibrous outer wall of the disc may weaken, and it may no longer be able to contain the gel-like nucleus in the center. This material may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and recreational activities lead to early disc degeneration.
How A Disc Is Replaced ?
Surgeons at the Cedars-Sinai Spine Center are at the forefront of development and evaluation of a safe and effective artificial disc. The evolution for hip and knee replacement has taken more than 40 years to reach its current stage of technology in materials, design and technique. Although the idea of an artificial disc is not new, artificial disc replacement technology has just in the recent decade become mature enough to be used clinically in extensive testing in Europe. The unique biomechanical challenges of artificial disc replacement have presented a challenge of both design and material.
Although revolutionary in material and design, the technique to install an artificial disc (whether in the neck or back) is routine and safe. In both traditional disc surgery and artificial disc replacement the procedure begins by removing the gelatinous disc between the vertebrae.
How Is A Diagnosis Made ?
When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understand your symptoms, any prior injuries or conditions, and determine if any lifestyle habits are causing the pain. Next a physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness.
Your doctor may order one or more of the following imaging studies:
- Magnetic Resonance Imaging (MRI) scan :is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine (Fig.2). Unlike an X-ray, nerves and discs are clearly visible. It allows your doctor to view your spine 3-dimensionally in slices, as if it were sliced layer-by-layer like a loaf of bread with a picture taken of each slice. The pictures can be taken from the side or from the top as a cross-section. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. An MRI can detect which disc is damaged and if there is any nerve compression. It can also detect bony overgrowth, spinal cord tumors, or abscesses.
- Myelogram :is a specialized X-ray where dye is injected into the spinal canal through a spinal tap. An X-ray fluoroscope then records the images formed by the dye. Myelograms can show a nerve being pinched by a herniated disc, bony overgrowth, spinal cord tumors, and spinal abscesses. Regular X-rays of the spine only give a clear picture of bones. The dye used in a myelogram shows up white on the X-ray, allowing the physician to view the spinal cord and canal in detail. A CT scan may follow this test.
- Computed Tomography (CT) scan :is a safe, noninvasive test that uses an X-ray beam and a computer to make 2 dimensional images of your spine. Similar to an MRI, it allows your doctor to view your spine in slices, as if it were sliced layer-by-layer with a picture taken of each slice. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. This test is especially useful for confirming which disc is damaged.
- Electromyography (EMG) & Nerve Conduction Velocity (NCV): EMG, often done with a NCV study, measures your nerve and muscle response to electrical stimulation. Small needles, or electrodes, are placed in your muscles, and the results are recorded on a special machine. Because a herniated disc causes pressure on the nerve root, the nerve cannot supply feeling and movement to the muscle in a normal manner. These tests can detect nerve damage and muscle weakness.
- X-ray : tests use X-rays to view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, or fractures. It's not possible to diagnose a herniated disc with this test alone.
Bryan Cervical Artificial Disc
The surgical procedure to implant a Bryan cervical artificial disc is similar in approach and technique to traditional cervical spine surgery that has been used for more than five decades. A small incision, usually less than an inch long, is made in the skin of the neck just off the midline of the spine. Vital structures like nerves, arteries and the esophagus (the tube that connects the mouth and the stomach) are gently pulled out of the way so the surgeon can have access to the spine.
The disc is removed using a microscope and surgical instruments made for this purpose. Once the disc has been safely removed in its entirety, the empty disc space is prepared by milling or shaping the endplates (bottom of each vertebrae) to incorporate the Bryan cervical artificial disc replacement. The artificial disc is placed while the disc space between the two vertebrae (the bones of the spine) is held open.
Once firmly in place, tension is taken off the vertebral bodies above and below compressing the artificial disc and holding it in place. Both surfaces of the Bryan cervical artificial disc are made of porous beaded titanium metal that will incorporate and encourage bony ingrowth for long-term stability. The metal endplates surround a polyurethane core and saline cushion. Care and restrictions following surgery, as well as potential complications, are similar to those that occur with spinal fusion.
Charite Lumbar Artificial Disc
Charité SB-III lumbar artificial disc replacement is performed by a team of fellowship-trained surgeons who have different areas of expertise. The first step of the surgery is to make a small incision low on the abdomen below the navel. This is done by a special surgeon and is designed to spare the muscles any unneeded damage and safely move away nearby blood vessels and organs. This makes it possible for the spine surgeon to safely work on the appropriate level in the spine. The spine surgeon cleans away and completely removes the damaged disc from the bones of the spine.
Two metal plates are pressed into the bony endplates above and below the space now vacated by the disc. Metal spikes hold these plates in place on the bone. Eventually bone will grow over and around the metal plates. A plastic spacer made of a polyethylene core is put between the plates. The patient's own body weight compresses the spacer after the surgery is complete. The device allows for six degrees of freedom.
Recovery from artificial disc replacement and care afterwards are much like that for other anterior approaches to lumbar spine surgery. In some cases, recovery is faster than for a traditional fusion surgery. There is less pain from the procedure and fewer complications in general. The materials used in both artificial disc replacements are similar the materials used in routine hip and knee replacement surgery. The materials are designed not to cause sensitivities once in the body.
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