Contents
In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
The predominant feature of this ailment is pain. Tearing, piercing. Such that we have to freeze in one position because we cannot take even a step. Neither tie shoelaces nor raise glasses. What kind of illness is that? Discopathy.
Until recently, it was believed that discopathy is a disease of the elderly. This is not true – you can get sick at the age of 75, but also 25. The fact that discopathy more and more often affects young people is influenced by civilization “sins” – a sedentary lifestyle and lack of exercise. It is not easy to win, treatment must be started early, and consistent rehabilitation is also necessary.
Disk like a prune
Discopathy is a disease of the intervertebral disc, called the disc. To understand what it is, it is important to understand the structure and function of the disc, an important part of the spine. It acts as an insert, a “cushion” between the vertebral bodies and acts as a shock absorber. The disc is actually disc-shaped. It is composed of a pulmonary nucleus and a fibrous ring surrounding it. This ring consists of concentrically embedded lamellae which spring together with the disc. All vertebral bodies, from the cervical to the lumbar spine, are equipped with discs, which additionally stabilize the complex ligament system. Unfortunately, over the years, degenerative changes occur in the disc itself. Gradually, it loses its elasticity, flexibility and so-called hydration, that is, from a juicy plum turns into a dried one. In addition, it is more prone to damage, which makes it unable to act as a shock absorber.
What is conducive to the degenerative processes of the disc? There can be many reasons, e.g. a sedentary lifestyle and little exercise, stress, injuries, obesity, osteoporosis, heavy lifting, competitive sports, and seasonal sports (without proper preparation). It is especially prone to discopathy by bending down on straightened legs with arms stretched forward, especially with repeated twists of the spine.
Since the contents of the disc are not innervated, the discopathy is initially not felt. Its first sign is the limitation of the spine’s mobility. And when you get pain, it means there is a hernia (disc deformation) or a more serious condition called a hernia (disc rupture). Untreated discopathy gradually worsens, degenerative changes become permanent, deepen and spread to the adjacent spaces between the vertebrae. The entire spine becomes ill.
The disastrous consequences of oppression
Symptoms of lumbar discopathy are easy to capture – there is pain in the lower spine, radiating along the nerve pathways. It worsens when walking, there may be numbness and tingling in the affected parts of the body, and muscle weakness and paralysis may occur.
Discopathy in the cervical spine is less common than in the lumbar spine. This is usually due to an injury (sudden jerk), for example in a traffic accident. Symptoms include chronic pain in the neck and nape, sometimes accompanied by brachial plexus neuralgia (if the herniation starts pressing against the spinal root).
Discopathy may be chronic. The process of pathological changes within the disc leads to a gradual damage to the fibrous ring or displacement of the nucleus pulposus.
Fragments of this nucleus may invade into the spinal canal. Then there is pressure on the nerve roots running there, which is manifested in a strong, shooting pain. Local swelling may appear in the place of pressure (compression) on the nerve, which additionally increases the pressure on the nerve and intensifies pain. In more advanced states, chronic compression may cause disturbances in the blood supply to the nerve root,
and consequently lead to its death. The effects are fatal: paresis of the lower limbs, sensory disturbances, weakened muscle strength, weakened reflexes, foot drop.
Treatment begins with medications
If the pain is severe, it is necessary to spend several days (or even weeks) in bed and use medications to relieve pain, swelling and inflammation, as well as relax the muscles. The pain stops slowly and gradually. Let’s not expect to get rid of it quickly. Medicines are important in the treatment of discopathy, but only in the acute period. Then rehabilitation (physical treatments) or cryotherapy is necessary – appropriately tailored for each patient. Exercise is of great importance, but must be individually consulted with an experienced physiotherapist. Incorrectly selected or improperly performed can do us more harm than good.
If medications and rehabilitation fail, and the pain still haunts us, we should be referred to a neurosurgeon. On the basis of an interview, neurological examination, magnetic resonance imaging or other necessary tests, he will assess whether an operation will be necessary, and if so, he will issue a referral. Surgery is considered a last resort and is considered only when there are symptoms of pressure on the nerve roots of the spinal cord. It is estimated that only about 3% of patients with lumbar discopathy require surgery. In most cases, patients need appropriate treatment and rehabilitation under the supervision of an experienced physiotherapist. On the other hand, in cases of advanced discopathy, if the operation is not performed in a timely manner, the patient is at risk of limb paresis.
Artificial discs and titanium screws
A miracle cure has not yet been invented that would effectively eliminate all symptoms of discopathy. More than once, patients have to contend with disease and pain throughout their lives. There are many surgical methods to choose from, but only a doctor – based on the history and test results – can decide which one to choose.
Traditional surgical methods are modernized today, for example, during the surgical removal of the nucleus pulposus, an artificial disk is implanted. It is an operation recommended for patients with lumbar discopathy in whom the disc has not significantly prolapsed into the spinal canal. In the case of advanced degenerative changes (e.g. spondylolisthesis), the classic method of removing nucleus pulposus in the lumbar spine is used, and a carbon implant is placed in the place after removing the disc. Then, titanium screws connected with titanium rods are screwed into the vertebral bodies. Unfortunately, the spine loses mobility in the operated section.
Optical fibers and lasers
An endoscope is a device with a built-in camera to which an optical fiber is attached. Through a small cut in the skin, it is introduced near the disk, thanks to which the neurosurgeon can control the operating field on the monitor screen. This allows you to maintain the precision of the treatment that affects such an important part of the body as the spine.
Many endoscopic methods are used in the treatment of lumbar discopathy, such as percutaneous endoscopic discectomy (ME). The endoscope is inserted through the posterior and lateral access of the spine to the area of the intervertebral disc, but bypassing the spinal canal. The indications for this operation are cases with a slight dislocation of the nucleus pulposus and in young people who have not yet been affected by degenerative changes in the spine. A certain disadvantage of this method is that it is not possible to remove a fragment of the nucleus pulposus that has been displaced into the spinal canal.
The second type of endoscopic technique is microendoscopic discectomy (MED). It is recommended when the intervertebral disc is significantly displaced into the spinal canal. The neurosurgeon must then open the spinal canal through appropriate procedures in order to decolor the nerve structures. The advantage of this method is low invasiveness (the incision in the skin is small, 1,5-2 cm) and the fact that the muscles are detached without cutting them. The effectiveness of the treatments reaches 80%.
Other modern methods include percutaneous laser disc decompression (PLDD). This procedure uses a medical laser. The neurosurgeon inserts a special needle into the diseased disc, and its insertion is monitored using an X-ray machine or a computer tomograph. A light guide is placed in the needle, the end of which is connected to the laser. An appropriate dose of energy is generated, which allows the removal of the nucleus pulp fragment and evaporation of the water. As a result, the pressure inside the disc is lowered, causing it to ease or reduce pressure on the nerve structures. The procedure takes 15 to 30 minutes and is performed under local anesthesia.
Modern endoscopic or laser procedures have many advantages: minimal invasiveness (small incisions slightly affect the muscles of the spinal canal), fewer complications and recurrences of the disease, and shorter rehabilitation time compared to traditional procedures. Nevertheless, among orthopedic doctors, opinions about their effectiveness are divided.
Convalescence and its course depend on the result of the procedure, and the comparison of the symptoms before and after the surgery. Usually, a program of habits, behaviors and targeted exercises is established – to protect the spine.
Text: Anna Romaszkan
Consultation: lek. med. Janusz Mikołajewski, orthopedic surgeon, LUX MED Medical Center, ul. Postępu 21c, Warsaw
Source: Let’s live longer