Treatments for spinal degeneration and vertebral instability
- Slipped disc
- Disc degeneration
- Spinal tumours
- Vertebral fractures
- Vertebral instability (spondylolisthesis, degenerative scoliosis)
RANGE OF TREATMENTS IN SPINAL SURGERY
- Prosthetic intervertebral disc replacement
- Decompression and nucleotomy
- Dynamic reconstruction and stabilisation for instabilities and degenerative scoliosis
- Decompression for spinal stenosis
- Reconstruction following vertebral fractures and tumours
- Vertebral augmentation for osteoporosis
SLIPPED, HERNIATED, OR PROLAPSED DISCS
A slipped, herniated, or prolapsed disc is a result of degeneration and destruction of the disc’s fibrous outer ring and gelatinous core Chronic stress on the disc, lack of regenerative capacity of the tissue due to age, or injury of the cartilage plates of the adjacent vertebral bodies can lead to decline of the disc tissue. The lack of blood supply in the disc then inevitably leads to a process of degeneration. Inflammatory substances damage the disc and promote a cascade of degradation of the tissue. This leads to tears in the fibrous outer ring which, under pressure, allow part of the fibrous ring or the soft core of the disc to push outwards, presenting itself as a disc herniation or prolapse.
If there is no indication of nerve damage in the form of abnormal sensation, numbness or paralysis of the arms, hands, legs or feet, conservative treatment over several months is recommended. If there is no permanent improvement of symptoms and pain after this period, however, surgical treatment is usually unavoidable. Indications for surgery include persistent nerve paralysis in the hands or feet, strong, non-treatable pain and acute bladder and/or rectal paralysis.
For surgery of the lumbar spine, the spinal canal is usually accessed from behind through a small incision just a few centimetres in length, with the aid of a microscope or endoscope. Compressed parts of the herniated disc can then be removed from the spinal canal, relieving stress on the nerve roots. Discs destroyed by degenerative processes cannot be reconstructed by this type of treatment, however. The collapse of the segment remains, with the pathologies as described. If the symptoms recur, implantation of a disc prosthesis should be considered.