CAUSES OF CHRONIC BACK PAIN: Herniated Disc

Anatomy

The intervertebral discs are found between each vertebrae in the human spine. Like the vertebrae, there are 7 cervical (neck), 12 thoracic (mid-back) and 5 lumbar (low back) discs. The discs make up approximately 1/3 of the spinal column. Their function is to: (1) "absorb shock" from everyday wear and tear
(2) allow movement of our spinal column and (3) separate the vertebrae. The spinal disc is actually considered a type of cartilaginous joint. Discs consist of an outer annulus fibrosis layer and an inner nucleus pulposis, which is a soft, jelly-like, substance. The disc is made up of proteins called collagen and proteoglycans that attract water. Normally, discs compress when pressure is put on them and decompress when the pressure is relieved.

Discs do not have a blood supply and exchange nutrients by a process called "imbibition". Imagine a sponge with water, when you compress the sponge you release water. When you remove the compressive force, water is "sucked" back in the sponge. This is exactly how discs work and the importance of healthy discs.

Diseased discs can lead to: Degenerative Disc Disease which can lead to: Arthritis, Herniated Disc, Facet Syndrome, and Spinal Stenosis.

Condition: Herniated Disc

Herniation describes an abnormal condition of an intervertebral disc that is also referred to as a "slipped" disc, "ruptured" disc or "blown" disc. It is not known what causes the disc to herniate but it is thought to occur from (1) Trauma (2) repetitive stress due to occupation, poor posture or other external factors and the (3) natural processes of aging. The process of herniation occurs when the inner nucleus pulposis bulges through the annulus fibrosis causing a protruding disc which may push on a spinal nerve. It can progress to the point where the inner material (nucleus pulposis) leaks out of the disc. When this happens, the body mounts an auto-immune response to the disc material (nucleus pulposis) which causes severe inflammation and progressive deterioration of the nerve root. If the herniated disc is located in the cervical spine (neck), the symptoms can be neck pain with/without arm pain and/or numbness. If the herniated disc is located in the lumbar spine (low back), the symptoms can be low back pain with/without leg pain and/or numbness. This type of pain and/or numbness in the legs or arms is referred to as a "Radiculopathy". This is due to the fact that the nerves that exit your spinal cord innervate ("attach to") the skin in your arms and legs (responsible for sensation), muscles in your arms and legs (responsible for movement) and reflexes in your arms and legs. This is why some people with these conditions experience extremity (leg/arm) pain/numbness/tingling and weakness when they have a disc herniation. Surprisingly, people with herniated disc may only complain of extremity (arm/leg) pain with minimal neck or low back pain.

Diagnosis: Herniated Disc

Diagnosis of a herniated disc (either neck or low back) can be made from a detailed physical examination including a detailed Orthopedic & Neurological examination. Typical disc patients will present with an antalgic gait (lean away from the side of the disc lesion), extremity pain/numbness/tingling (abnormal sensation) in addition to neck or low back pain. In more chronic cases, muscle weakness may be present as may areflexia ("loss of reflex"). X-rays can help identify the level of the disc herniation but a MRI is the "gold standard" to identify the exact nature of the lesion. When the disc is herniated in the lumbar spine (low back), it is often referred to as Sciatica.

Treatment: Herniated Disc

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID's), Physical/Chiropractic Therapy, Epidural Injections or Surgery. NSAID's have an inherent risk of Gastrointestinal ("stomach" and "intestine") disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in the New England Journal of Medicine reported that it has been conservatively estimated that 16,500 NSAID-related deaths occur every year in the United States and conservative calculations estimate that approximately 107,000 Americans are hospitalized every year due to NSAID related GI complications. The number of deaths reported in the same study due to AIDS was 16,685. In addition to Gastrointestinal disorders, drugs such as VIOXX have been known to cause serious Cardiovascular (CV) events such as: Heart Attacks, Stroke and Heart Failure. There have been similar complaints from other NSAID's such as: Bextra and Celebrex.

Epidural injections ("injection within the epidural space of the spinal cord") with corticosteroids, lidocaine or opiods have no proven benefit in treating acute neck or upper back symptoms. In those that do improve, the effects are often temporary and require repeat injections, several per year, not to mention the chances of contracting a spinal infection which can lead to meningitis. In fact, the results of a randomized, double-blind trial published in the June 2003 issue of the Annals of Rheumatic Diseases indicated that an Epidural Steroid Injection was no better than an Epidural Saline ("salt water") Injection (i.e. placebo) for Sciatica. These findings are consistent with those of another definitive trial presented at the last American College of Rheumatology meeting.

Although, there have been advances in spinal surgery, the outcomes can be very unpredictable, failed back surgery/post-operative pain syndrome is a very disabling and troubling reality of surgical intervention. An article in Spine reviewed the outcomes and complication rates for surgical intervention in Degenerative Disc Disease. Complication rates were as high as 55% and included: hematoma, neurologic, adjacent segment degeneration, infection and hardware/instrument related issues. Another study to determine the effects of single level (2 vertebrae) and 2-level (3-4 vertebrae) spinal fusion success rates reported 53% with "good" and "fair" results with single level fusion and no "good" results with 2-level fusions .

Now that you have read about the possible side effects of what traditional treatments have to offer, you may want to consider the drugless, non-surgical approach that Non-Surgical Spinal Decompression has to offer.

Non-Surgical Spinal Decompression: Herniated Disc

The following is the rationale, based on anatomical and physiological principles, of Non-Surgical Spinal Decompression. Non-Surgical Spinal Decompression offers to treat the root cause of the disease - compression of the disc. Non-Surgical Spinal Decompression relieves pressure from the disc, which relieves pressure from the nerve. In addition, research has shown that Non-Surgical Spinal Decompression can create a negative pressure within the disc causing a "vacuum effect". This vacuum effect can "suck" the disc material back inside thus relieving the pressure from the nerve. Non-Surgical Spinal Decompression also allows for strengthening of the outer ligament bands that hold the disc material in place and which become weak and stretched during the bulging effect. In cases where the disc has herniated causing an inflammatory auto-immune response, Non-Surgical Spinal Decompression can facilitate a healthy exchange of nutrients ("imbibition") through its "pumping action" thus eliminating the inflammation at its source - the nerve root.

Thus, Non-Surgical Spinal Decompression for herniated discs is based on the following principles:

(1) Decompression of the involved Disc. Creating…
(2) A Negative intradiscal ("within the disc") pressure. Creating…
(3) A Vacuum effect which…
(4) Reduces ("sucks in") the size of the herniation which…
(5) Takes pressure off the involved nerve root which…
(6) Reduce/eliminates extremity (leg/arm) pain and/or numbness

While at the same time

(7) The pumping motions caused by Non-Surgical Spinal Decompression
called "imbibition"…
(8) Allow nutrients to be exchanged at the level of the disc and inflammation around the nerve root to be dispersed causing…
(9) A reduction/elimination of low back pain.

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