Herniated Disc. What is it?

By Moses Jacob, DC
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Herniated Disk

Spinal Motor Unit is described as two vertebrae and the disc between them.

What is the disc (IVD)? The IVD disc is a horizontally positioned cushion comprised mainly cartilage. Most of the disc is made of strong crossed circular fibrous tissue. The center or nucleus is comprised of a gelatinous material. The back of the disc lies in close proximity to the exiting spinal nerves. Nutrition of healthy discs occurs via osmosis. The outer disc fibers are innervated. There is poor blood supply to the inner disc.

What is disc herniation? Disc disorders range from mild to severe breakdown or leakage of the nucleus, most commonly back wards or laterally.

The term herniated disc, refers to localized displacement of nucleus, cartilage, fragmented bone, or annular tissue beyond the IVD space. The IVD space is defined, superior and inferior aspects of the relative vertebrae.

Protrusion/extrusion refers to the degree, volume and location of nuclear material has been displaced. (From: Nomenclature and Classification of Lumbar Disc Pathology, Spine Journal by Fardon and Milette)

Small bulges, protrusion as well as frank herniation may occur from natural aging or injury(ies), including repetitive traumas.

Treatment Options: Disc herniations may be accompanied by back pain coupled with radiating pain in the upper extremities (cervical disc) or lower extremity pain (lumbar disc w/ sciatica). Mid-back, i.e. thoracic spine herniation occurs less of often.

Conservative care is most often the first line of care. Such treatment can include use of ice (in acute injury) followed a day or two later by heat. The combination of Spinal Manipulation most often by a licensed chiropractor in combination with appropriate exercises. See William’s Flexion and McKenzie extension exercise protocols.

The chiropractic profession offers a variety of SMT methods. These include classic spinal adjustment (SMT) to distraction methods such as Cox.

Science based support for Chiropractic SMT as treatment of Disc Herniation:

Spine J. 2006 Mar-Apr;6(2):131-7. Epub 2006 Feb 3. ” Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations” by Santilli V.

CONCLUSIONS: “Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.”

Other types of non-invasive care include acupuncture and massage.

Unless there exist “RED-FLAGS” clinical findings, e.g. loss of bladder function, bowel disorder, atrophy, other neurologic findings surgery should be considered as a final resort. Also should conservative care had Failed then surgery may be considered as an option. In recent years several state Worker’s Compensation programs (Ohio and Oregon) have passed laws, recommending that spinal manipulation be tried prior to proceeding to spinal fusion surgery.

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