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The disc is part of the
spine that has received a lot of attention in recent years. We
hear the terms "slipped disc", "ruptured disc",
"herniated disc", "prolapsed disc" but what
do these terms really mean?
What is the Intervertebral Disc?
The disc is a structure located
between the spinal bones (vertebrae). Because it's found
between the vertebrae it's officially called the invertebral
(inter-between, vertebral-the
vertebrae) disc.
The disc is made up of two parts:
a tough fibrous outer ring (called the annular fibrosis) and
the gel-like centre (the nucleas pulposis).
Functions
The intervertebral disc performs
many functions. It separates the vertebrae and acts like a shock
absorber between the bones. It helps give the spine its curves
and also joins the vertebrae together. There are 23 discs in
our spinal column. In fact, in the morning we are about a quarter
inch to half inch taller than we were the night before because
the discs lose fluid alter a day of standing and thin out a little,
causing us to lose some height.
The Disc and Spinal Pain
Today researchers are in general
agreement that disc lesions are the single most common
cause of lower back pain. What is the disc lesion?
Disc Protrusion and Prolapse
Surprisingly, the disc may start
showing signs of wear and tear as early as age 15. Over the years
the disc loses a little fluid and small cracks (lesions) begin
to form in the outer walls. The nucleus pulposis begins to bulge
and push the annular fibrosis out of shape. This is called a
protrusion. If the part bulges out too much it may actually separate
from the rest of the disc and become a disc
prolapse.
If the prolapsed disc goes into
the spinal cord or puts extreme pressure on the nerves it may
cause severe pain that could make sitting, standing, walking,
lifting, urinating, defecating, sneezing, coughing and moving
nearly impossible. In extreme cases numbness of the leg or foot
or a loss of
muscular control may occur.
Slipped Disc
The term "slipped disc"
is really a misnomer since the disc cannot slip - it is knitted
into the vertebrae from both above and below. What sometimes
do slip are the vertebrae, which if they do slip out of position
may put pressure upon the disc and contribute to its damage.
Most accurately called "slipped discs" would probably
be more accurately called slipped vertebrae or disc prolapse.
Organic Disease
Disc degeneration often damages
lumbar and sacral nerves of the lower spine. Because of
that various conditions in the pelvic area may occur. Among these
are endometriosis, infections (bladder, vaginal, kidney), prostate
problems, miscarriage, sterility, sexual impotence, problems
of urinary retention, cystitis, menstrual cramps and constipation.
It is not uncommon for an individual who has a chronic back problem
to suffer from one or more of the above problems as well.
The Medical Approach to Treating
Disc Problems
The medical approach to disc
problems is often a combination of pain killer, muscle relaxants
and physical therapy, which may involve traction, electrical
stimulation and exercises. Sometimes a myelogram is performed
to diagnose disc problems. This involves injecting dye into the
spinal cord
and then X-raying the area to see if the dye is going into places
it shouldn't - a sign of rupture or tearing of the disc. The
problem with myelograms is that they have a large margin of error
(30-40%). Their use is being abandoned by many specialists.
Back Surgery
If the medical treatments fail,
then back surgery, usually performed by an orthopaedic
surgeon may be suggested. The surgery often performed is called
a laminectomy. It can
involve the removal of the back of the vertebrae and the scraping
away of the disc.
With no disc between them the vertebrae may fuse into a solid
bone. In some procedures pieces of bone are scraped away from
the hips and are applied to the exposed vertebrae.
How successful is orthopaedic
surgery?
Following laminectomy, symptomatic
improvements such as lessening of the pain is often short lived.
After about six months to one year there isn't much difference
between patients who had the surgery and another group that did
not.
The Chiropractic Record
Chiropractic has an excellent
record with disc sufferers, often saving then from the bleak
prospect of surgery. Chiropractic care is also often effective
at helping those who already have gone through orthopaedic surgery.
According to one study of 1.536 lumbar spinal problem patients
who were under chiropractic care, 96.4% had a satisfactory result!
Surgery was resorted to in only 3.4% of the patients. This study
showed two things:-
- Chiropractic care is extremely effective with spinal disc
problems
- Of those that had surgery, the delay in time while they explored
chiropractic care did not cause them any harm
What if you've had surgery?
But what if a person has had spinal surgery, you ask? Yes,
it is possible for a chiropractor to adjust someone's spinal
column if they've had surgery.
Although the surgery may have permanently altered some of
the spine, it is still not too late for chiropractic care. The
chiropractor won't be able to undo the surgery, but can often
help relieve the pain and may prevent the need for future operations.
Prevention
The best results of chiropractic care are the ones you never
hear about - the health problems that we prevented from getting
worse because of prompt action.
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