The shock-absorbing discs that separate the bones in the spine are probably the most common reason for spine surgery. The disc is much like a jelly doughnut, in that there is an outside wall to the disc and a soft center. The “jelly” is the inner spongy portion of the disc, called the nucleus pulposus. Encircling the jelly nucleus are hard bands of fibrous tissue called the annulus fibrosis, or disc wall.
With age, the disc can become more brittle and susceptible to herniation or rupture. Years of strain, and poor body lifting form, can take a toll. One day, a sudden stress from lifting can cause this weakened disc to rupture, allowing the jelly center to squirt out of the disc space. This jelly contains chemicals which are extremely irritating to the nerves, which can also cause swelling.
Because the nerve roots act as telegraph lines to other parts of the body, a common complication of disc herniation is that it can cause pain that is felt in other parts of the body, like the leg. In fact, leg pain below the knee is a common herniated disc symptom. This radiating pain is called radicular pain or radiculopathy.
Your physician will request diagnostic testing to help determine the best treatment plan.
- X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the spaces between the bones.
- MRI (Magnetic Resonance Imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Because X-rays only show bones, MRIs are needed to see soft tissues like spinal discs. These images help your doctor provide a more accurate diagnosis. MRIs are very safe and usually pain-free.
- CT scan/myelogram - A CT scan is similar to an MRI because it provides additional diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
- Electrodiagnostic - Electrical testing of the nerves and spinal cord may be performed as part of our diagnostic workups. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your physician in understanding how your nerves or spinal cord are affected by your condition.
- Bone scan - Bone imaging is used to detect infection, malignancy, fractures and arthritis in any area of the body. Bone scans are also used to find lesions for biopsy or excision. Click here to learn more about bone scans.
- Discography - Discography is used to determine the internal structure of your disc. It is performed with a local anesthetic by injecting dye into the disc under X-ray guidance. An X-ray or CT scan is performed to determine if the disc’s structure is normal or abnormal and if the injection causes pain. A benefit of a discogram is that it enables the spine surgeon to determine the disc level that is causing pain. This ensures that surgery will be more successful by reducing the risk of operating on the wrong disc.
- Injections - Pain-relieving injections can act as a
bridge to physical therapy by relieving back pain and providing the
physician with important information about your problem.
Unlike muscles which can heal somewhat quickly, a torn or degenerated disc heals more slowly. The good news is that in many cases, the pain and inflammation originating from damaged discs can be treated nonsurgically by reducing the inflammation and by strengthening the musculature surrounding the damaged disc to give it more support.
TriCities Spine in Bristol, TN is a by-product of discussions with case managers, rehab nurses and managed care experts on a local and national level who believe that spine care can be improved through a multidisciplinary team approach. TriCities Spine includes a board-certified neurosurgeon who specializes in spine, Dr. Jim Brasfield, teamed with a pain management specialist and spine-specialized physical therapy. TriCities Spine physicians already see a variety of complex cases from across Eastern Tennessee, Virginia, North Carolina and Kentucky. TriCities Spine emphasizes a nonsurgical approach to back pain, recognizing that in most cases spine surgery should be the last card to be played after nonsurgical options have been tried. About half of patients are referred to TriCities Spine by other doctors in the region. TriCities Spine also cares for those who injure themselves at the workplace. The strength of TriCities Spine lies in the medical expertise brought in by a variety of specialists who complement each other, including experts in physical medicine and neurosurgery. An internal pain specialist is often able to relieve some back and neck pain symptoms with special injections that enable a patient to bridge to therapy. Dr. Fred Terry specializes in pain relieving lumbar spinal injections and as well as myelograms, which may reveal the amount of damage in the spine. Therapists who specialize in spine use customized hands-on treatments to relieve pain symptoms, along with special exercises to help make the back stronger, more flexible and resistant to injury. If nonsurgical treatments are not successful, Dr. Jim Brasfield is trained and proficient in the latest techniques in minimally invasive spine surgery. Because of the minimally invasive techniques used by Dr. Brasfield, many patients are able to have their spine surgery and then return home the same day to recover in the comfort of their own home.