The lumbar spine is separated by flexible structures called inter vertebral disc. The disc has a central gelatinous core contained in an outer casing. A disc prolapsed occurs when this gelatinous core called the nucleus comes out through tears in the outer casing and irritates the nerves going to the leg causing pain and sometimes numbness and weakness in the leg. Treatment initially is with a short period of rest and medications, but if the pain is very severe and associated with significant numbness or weakness in the legs or any difficulty in passing urine, a surgical method of treatment is adopted. The surgery for a lumbar disc prolapsed is called a micro lumbar discectomy, using an operating surgical microscope and through a small key hole incision. The patient notices immediate pain relief and is able to walk on the same day and goes home the next day.
Cervical disc prolapse
The disc nucleus in the neck or cervical portion of the spine can also come out and irritate the nerves causing pain, numbness and weakness in the arm and hand. In this condition if medical treatment fails surgery is recommended and it is done by an approach from the front of the neck and after removing the offending disc it is replaced with a metal spacer or artificial disc.
Lumbar canal stenosis
The spine undergoes degenerative changes with age. This sometimes causes narrowing of the space in which the nerves to the lower limbs pass through the spine. The patient notices pain in the legs on standing and walking and finds that progressively his walking distance reduces. Since the problem is a mechanical compression of the nerves, it does not respond to medical treatment, and if disabling surgery is warranted. The surgical procedure basically consists of creating a space for the nerves by removing the abnormal bone and tissue compressing the nerve. Sometimes this procedure is combined with putting screws and roods to hold and fuse the spine if there are abnormal movements and shifts between the spines which also contributes to the mechanical compression
The changes of aging can affect the neck (cervical spine) and in some instances cause compression of the spinal cord with progressive paralysis. Treatment is surgical with decompression and stabilization of the cervical spine.
Spinal Deformity – Scoliosis
Scoliosis is a deformity of the spine where it is bent to the side. It can be present from birth due to improper formation of the spine, be present in several diseases affecting the nervous system like cerebral palsy, muscular dystrophy or have an unknown cause especially in adolescents. If the scoliosis is one which is present from birth, it will have a high chance of requiring surgery. Smaller curves are treated with a brace but larger progressive curves require surgical stabilization and fusion.
In this condition one vertebra slips over the other. It can cause disabling back pain and symptoms of nerve compression. It can be surgically corrected and fixed.
The spine can sustain a fracture or dislocation and this can be particularly devastating if it is accompanied by damage to the spinal cord. Like other bones in the human body modern fracture treatment involves surgically fixing damaged spine so as to prevent damage to the spinal cord and nerves and allowing earlier mobilization of the patient instead of prolonged bed rest.
The spine can be affected by infections of which tuberculosis is the most common. Though the mainstay of treatment is medical, surgery becomes necessary if the bone is destroyed and there is danger of deformity or paralysis or if these are already present.
The spine can be involved by tumors which can arise primarily in the spine or have spread to the spine from a site of cancer elsewhere in the body. Again apart from chemotherapy and radiotherapy, surgery is required to reconstruct a damaged spine to relieve pain and nerve compression.