An Intervertebral Disc is made up of two primary components. The first is the outer layer of fibers known as the annulus fibrosus. Think of this as the ‘dough’ in a jelly doughnut. The second portion is the inner material known as the nucleus polposus which can be compared to the ‘jelly’ portion of the doughnut. The nucleus of the disc acts as a shock absorber, and a fulcrum, absorbing the impact of the body’s daily activities and keeping the two vertebrae separated.

In order for us to better understand the function of the disc think of the jelly doughnut again. What do you think would happen if you put some pressure on the front end of that doughnut? The pressure would force the jelly to move towards the back end. Of course, the exact opposite would occur if the pressure were on the other side. Your disc is no different since it acts as a fulcrum for movement. When a disc prolapses the jelly starts to ooze out and can put pressure on near by nerve fibers. This causes symptoms most commonly known as sciatica or radiculopathy such as numbness and tingling.

As we get older our tissues dehydrate and this limits the shock absorbing capacity of the disc. The annular fibers get weaker with age and begin to tear more easily when subjected to repetitious stress. In many cases this doesn’t cause pain, while in some is does.

In Medicine one generally refers to the gradual dehydration of the nucleus pulposus as degenerative disc disease or if accompanied by bony changes; spondylosis.

When the annulus fibrosus tears due to an injury or the aging process, the nucleus pulposus can begin to extrude through the tear. This is called disc herniation. Near the posterior side of each disc, all along the spine, major spinal nerves extend out to different organs, tissues, extremities etc. It is very common for the herniated disc to press against these nerves (pinched nerve) causing radiating pain, numbness, tingling, and diminished strength and/or range of motion. In addition, the contact of the inner nuclear gel, which contains inflammatory proteins, with a nerve can also cause significant pain. Nerve-related pain is called radicular pain.

A disc injury can be termed any of the following, depending on it’s severity; slipped disc, ruptured disc, bulging disc. In medicine there are three degrees of injury that can occur to a disc:

1. Disc Protrusiton

2. Extruded Disc

3. Sequesteration

Up until a few years ago surgery was the only option for those who failed therapy. A gap between these two groups left no other options for those who failed therapy. Soon you will learn about a new option that bridges the gap between failed therapy and surgery.

Surgery may be an option for those with significant neurological deficit that have failed therapy. Additionally, the presence of sever neurological symptoms known as cauda equina syndrome is considered a surgical emergency requiring immediate attention.

Regarding the role of surgery for failed medical therapy in patients without a significant neurological deficit, a meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that “limited evidence is now available to support some aspects of surgical practice”. More recent randomized controlled trials refine indications for surgery.

Surgical intervention should be a last resort only after all other means have been exhausted.

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