Slipped Disc:

A prolapsed disc is a condition when the inner, softer part of the disc bulges out through a weakness in the outer part of the disc. This bulging disc may then press on nearby nerves which in turn causes discomfort and pain. The symptoms include – back pain, ache in the arm or leg and pinpricks felt in feet, toes and hands.
Management

As a rule, surgery may be considered if the symptoms have not settled after about six weeks or so. At Apollo Hospitals, the spine surgeons may opt for:

Keyhole surgery – Also known as microdiscectomy spine surgery, it is typically performed when there is a prolapsed disc in the lumbar (lower back) region which is pressing against a nerve.

Disc replacement – An artificial disc is a device that is implanted into the spine to imitate the functions of a normal disc (carry load and allow motion). Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. The disc replacement for prolapsed disc is done in the cervical ( neck) spine.

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Apollo Hospitals

Spondylolisthesis:

Spondylolisthesis is a Greek term meaning slipping of the spine. It is the abnormal forward movement of one vertebra over the vertebra below. Most often, this forward slip of the vertebra occurs in the lumbar area of the spine. This slippage and herniation of the disc causes pressure on the nerve roots associated with the affected vertebrae, causing pain and dysfunction. There are various types of spondylolisthesis.

Type 1 – Congenital spondylolisthesis

An individual is born with the abnormality of the posterior bony arch of the spine, which causes the slippage. This is usually seen at the L5-S1 level and often associated with abnormality of the facet joints. Patients usually present with back pain during the adolescent growth spurt. CT and MRI scans are required to diagnose the dysplasia (abnormal bone formation).

Type 2 – Isthmic spondylolisthesis

Isthmic spondylolisthesis is caused by a defect in a part of the bone called the pars interarticularis. The pars bone connects the upper joint of one vertebra to the lower joint. The defect is usually caused by a stress fracture in individuals with a hereditary predisposition (some minor abnormality or weakness of the pars at birth). In certain individuals a defect may exist without any forward slip, referred to as spondylolysis. This itself can be painful.

Type 3 – Degenerative spondylolisthesis

Degenerative spondylolisthesis is a forward slippage secondary to arthritis of the spine. Spinal stenosis is usually associated with this process. This is due to a long standing degenerative disc leading to weak facet joints in the back of the spine. This is usually seen at L4-L5 level.
Management

In degenerative spondylolisthesis, surgery is indicated if slippage progressively worsens or if back pain does not respond to nonsurgical treatment and begins to interfere with activities of daily living. In the congenital and high dysplastic group, surgery is done at early stages to prevent neurological complications.

cervical disc replacement

The cervical spine is made of seven bones called as cervical vertebrae, which is piled on top of each other in the neck area.

Cervical disc replacement is a surgical procedure which involves in removing a damaged cervical disc and replacing it with an artificial disc. Cervical discs act as the cushion between the bones of the neck. Discs that get damaged due to various reasons can cause a lot of pain since the disc could move out of its original position causing a lot of pressure on the central spinal cord and at each vertebral level. Disc disruption can be a source of neck pain and can also cause neurological problems such as pain, numbness that starts from the neck passing through either the arms or one of it.

The initial treatment for this cervical disc symptom suggested by the doctors would be exercises and medications. But if the pain persists to continue for more than 6-12 weeks it is advisable to consider the option of surgery.
PROCEDURE AND RECOVERY:

The method used by the doctors for cervical disc replacement is an anterior cervical discectomy and fusion technique approach, whereby, they do the incision from the front of the neck which allows them to remove the damaged disc and the protruding disc which gives a great relief to the patient. In this kind of approach, a plate with screws is applied to the front of the spine to provide stability which helps in gaining solid fusion. The patient is under rest for a couple of days till the fusion is healed which is determined by an X-ray.

Until recently, the doctors use the method known as total disc arthroplasty approved by FDA which is similar to anterior cervical discectomy and fusion except the defect that is created by removing the disc between the two vertebrae is replaced with a disc replacement device. This device allows for free movement among the two vertebrae which is to be maintained and avoids the need of fusion.

The cervical disc replacement is performed on general anesthesia and they are discharged from the hospital on the same day or the next morning based on the surgeon’s advice. Pain from the procedure is very minimal and improves well within a short number of days. Most patients are capable of returning back to work within a couple of week’s time after a good rest.