1. The Shock Absorbers Between the Vertebrae
Between each of the body's vertebrae (neck and backbones) there is a disc of tissue that acts as a shock absorber. The outside of the disc is a round doughnut of tough gristle called the "nucleus annularis." In the middle of this doughnut is a soft spongy center called the "nucleus pulposis." This entire structure is called an intravetebral disc. These discs can degenerate, be squashed by trauma, and the annularis can pop allowing the soft center to squeeze out. When these things happen, anatomy can be distorted. The term "slipped disc" is used to describe this distortion.
2. What's Going On?
A "slipped disc" doesn't really slip very far. Everything surrounding a disc is wedged tightly together. The structures most commonly affected by disc abnormalities are nerves as they exit the spinal canal. A piece of disc, usually the soft nucleus pulposis, that is squeezed outside the doughnut of the nucleus annularis need not be very big to put pressure on a nerve and begin a vicious cycle of pain and muscle weakness. Likewise, if the disc "collapses" and allows the vertebrae to move together, spinal nerves easily become inflamed, also causing pain and weakness. An MRI of a slipped disc is the most accurate means of defining what is actually going on.
3. Pain, Weakness, Muscle Spasm--OUCH!
Fibers that carry impulses for pain and all parts of touch travel within spinal nerves, as well as nerves that go to muscles and cause them to contract. Consequently, when a slipped disc applies pressure to these nerves, pain, numbness and muscle weakness can all result. If a disc allows vertebrae to move toward each other, as in a collapse, then stiffness may result that limits normal head movement.
4. To Cut or Not to Cut
How to fix a slipped disc is an problem that has caused great debate for many years. Neurosurgeons, obviously, favor surgical intervention. Surgical procedures consist of removing pieces of discs that are pressuring nerves, stabilizing vertebrae by "fusing" them (placing a bone graft between them), opening up the bony canals through which nerves travel and an ever-evolving combination of these and other techniques. However, there is a growing body of evidence suggesting that some slipped discs do better with conservative treatment such as pain control, muscle relaxants, soft cervical collars and eventually physical therapy. There is no set rule of thumb that works for everyone. The nature of a patient's anatomy and the patient's age and lifestyle should all be considered.
5. Be Careful!
There are a variety of "alternative treatments" for cervical disc disease. These run the gamut from vitamin therapy to cervical manipulation. Any procedure that involves twisting of the neck or a thrusting manipulation must be approached with GREAT CAUTION. The anatomy of the cervical vertebra does not allow room for error. Attempts to shift structures around can cause life-long quadriplegia.
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