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Ask the Medical Expert Archives 2000-2004

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Disc Disease
August 2000

Q. I suffer with severe pain in my shoulder and neck. My doctor took an MRI/X-ray and found two huge bulging disks and suggested surgery. He said they would remove the bad disks and replace with bone, not mine but from someone else's. I never heard of this. He is also using Titanium to secure these new disks. This sounds different and I never heard of this kind of surgery. Is this a new procedure? What kind of surgery do you call this and should I get a second opinion?

A. Disc disease occurring in the neck or back is a serious problem and many treatment approaches are available. Surgery is the most drastic treatment, but necessary for some individuals with severe problems.

The discs act like shock absorbers in the spine, providing a cushion between the vertebrae which allows the nerves room to exit the spinal column. The nerves have motor fibers which travel to the muscles to allow movement, and they have sensory fibers supplying the brain with information on pain, pressure, temperature, and sensation. So if injury occurs to nerve fibers, some or all of these functions are impaired. Pressure on the nerves in the neck typically cause pain, weakness, numbness or tingling along the location supplied by the nerve as you describe. Disc problems may result from trauma or the aging process.

Treatment depends on the severity and duration of the problem. Milder occurrences of disc problems often respond to rest, medication, physical therapy, and modification of the conditions that may have caused the problem if those are known, for example changing the physical nature of one's job. If these measures are not working, more diagnostic tests are done including x-rays to show the bone structure, MRIs to look at the discs and nerves, and EMGs to examine nerve function. If the disc problem looks severe, other measures may be needed, including local cortisone injections or surgical measures. The cortisone injections attempt to reduce the swelling and inflammation around the nerve, and the surgery will remove damaged portions of the disc, widen the area where the nerve exits the spinal column, and restore stability to the spine. Various specific techniques are available to accomplish these goals.

Surgery is indeed a serious measure. A second opinion from a neurosurgeon would be worthwhile regarding both non-surgical treatment options, and specific surgical treatment.

HELPFUL WEBSITES:

  • http://www.neurosurgery.org/pubpages/patres/cervspnbroch.html
  • http://www.neurosurgery.medsch.ucla.edu/Diagnoses/Spinal/SpinalDis_1.html
MEDICAL REFERENCES (usually available through the library of your local hospital):
  • Profeta G, de Falco R, Ianniciello G, Profeta L, Cigliano A, Raja AI.
    Preliminary Experience with Anterior Cervical Microdiscectomy and Interbody Titanium Cage Fusion (Novus CT-Ti) in Patients with Cervical Disc Disease. Surg Neurol. 2000 May 1;53(5):417-426.
  • Gore DR, Sepic SB.
    Anterior Discectomy and Fusion for Painful Cervical Disc Disease. A report of 50 patients with an average follow-up of 21 years. Spine. 1998 Oct 1;23(19):2047-51.
  • Smith MD.
    Cervical Radiculopathy: Causes and Surgical Treatment. Minn Med. 1995 Apr;78(4):28-30, 42-5. Review.
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