I was googling today about spinal surgery and there are various options if the problem is a disc is herniated and pressing against a nerve or spinal cord.
You can have the part of the disc pressing against the nerve cut off (this involves burning off or cutting off 10% of the disc)
You can have the entire disc taken out and then have the vertebrae fused together
You can have the entire disc taken out and then have an artificial disc put in
But I didn’t see any options for a surgery to go into the spine and push the disc forward, then attach it to the vertebrae so it doesn’t become herniated again. Why is this not a surgical option? It sounds easier than cutting off part of the disc or replacing the whole disc, but because it doesn’t seem to be an option I’m sure there is a good reason. Why not treat it like an intestinal hernia, push it back into place then seal it up so it can’t herniate again.
I know there are forms of physical therapy that are supposed to move the disc back into place (McKenzie exercises, traction, inversion tables, decompression, etc) but why is there no invasive surgical means of doing what those therapies are designed to do? If a person is going in for surgery it means that PT failed.
Also as far as PT to move a disc back into place, why do they assume the disc will move away from the spine? I’ve heard the argument that decompression creates a ‘vacuum’ and this pulls the disc back into its proper position, but the disc seems like it could move anywhere on a 2D plane including sideways or press even harder against the spine. How do physical therapists know that an inversion table or traction won’t just cause the disc to herniate and press even harder against the spine?
If a disc has been squished/squahed into the cord or spinal nerve, you can bet it’s a pretty much beaten-up disc. So retaining it doesn’t serve much purpose (and technically might even be more challenging).
(posted as someone who’s undergone multiple spine surgeries, the last three of which were each over nine hours long :eek:)
I hadn’t thought of that. But as a counterpoint, there are surgeries to remove 10% of the disc and leave the rest there. They just remove the parts pressing against the nerves.
So keeping the disc is an option but why is cutting/burning 10% of it off an option but pushing it back into place is not a surgical option but is an option in PT?
I’ve had a multi-level lumbar fusion, a cervical artificial disk as well as lumbar and cervical microdiskectomies, so I’ve learned more than I ever wanted to learn about spines. :eek:
The disk is still attached to the vertebrae. Despite the misnomer “slipped disk” the disk didn’t slip out of place, so it can’t be pulled or pushed back into place. If it’s been herniated, it’s damaged, and they’re not known for having bountiful healing or regenerative abilities. They break, and stay broken.
Besides, if you wanted to push it back, you’d have to figure a way to not push too hard on the nerves as they’re between you and the disk. It’s safer to remove the offending portion as it can be cut free and pulled away from the nerves.
PT is all about being non-invasive and a hope that surgery might not be needed. Let’s say there’s a 50-50 shot that PT will work. In reality, it’s probably closer to 75-25 that it will be useful.
If PT doesn’t work, there’s really no harm done as you can move on to having surgery, but would you accept a 50-50-chance that surgery to patch or reposition a damaged disk might not work? What’s “Plan B” if surgery fails?
I’ve heard the ratio is closer to 90-10, about 90% of people recover w/o surgery. And I’ve heard going out 2-5 years when comparing people who did surgery vs conservative treatments, both groups were pretty much the same. Surgery, to me at least, sounds like a high risk/low reward situation. That is the impression I’m getting.
What I don’t understand is why is moving the disc ‘back into place’ such an integral part of PT, but not a part of surgery. Inversion tables, traction, spinal decompression, McKenzie, etc. They all aim to move the disc forward and away from the nerves. But there is no surgery to do the same thing.
See here to see what is happening with a herniated disc.
After the anulus fibrosus breaks down or ruptures, the nucleus pulposus bulges out and compresses the nerve or spine.
If you think of a disc as a flat jelly-filled doughnut, you can see that trying to push the jelly back into the doughnut would not be very easy…
How would you “attach” this very soft substance to something solid like the vertebral body?
What non-invasive techniques try to do is lessen the compression on the herniation so that it has time to toughen up and heal.
This is pretty much it. A partial discectomy removes the part of the disk sticking out. The reason it’s sticking out is that the adjacent vertebrae are pressing on it. It hasn’t moved; as Chief Pedant explained, the nucleus propulsus is sticking out of it. If you poked the NP back into place (assuming you could) it would just squeeze out again as soon as the patient was upright.
A more practical alternative would be to insert something between the adjacent vertebrae to keep them from pressing on the disk. But it turns out the disk fits more or less flush between them, so you can’t - hence disk replacement.