The Spine

Herniated disc

A condition where the jelly-like nucleus pulposus leaks through a tear in the annulus fibrosus, causing discomfort and potential nerve compression. most common in lumbar and cervical

Stages of herniated discs

normal, degeneration, prolapse, extrusion, sequestration/herniation/rupture

Causes for herniation

changes in the disc: degeneration (less water), clumping of the NP, mechanical compression

aging, prolonges sitting, obesity, heavy lifting, repetitive bending/twisting

Cervical symptoms

cervical radiculopathy, pain between shoulder blades/neck/chest —> radiates to arm/hand, numbness/tingling in arms

Cervical radiculopathy

A condition resulting from the compression of nerve roots in the cervical spine, leading to pain radiating from the neck to the arm and hand.

Lumbar symptoms

sciatica (shooting pain down leg), back pain, tingling/numbness in legs/feet, muscle weakness

Sciatica

Nerve pain that shoots down the leg, often associated with a herniated disc in the lumbar region.

Diagnosis for herniation

MRI - shows the disc and each of its parts, location, severity and nerve pressure

X-Ray - Rules out other causes of back pain (tumor, infection broken bones, spinal alignment issues)

CT Scan - helpful if disc is calcified

Myelogram - Dye is injected into the spinal fluid and shows pressure on the spinal cord/nerves

Management for herniation

NSAIDs, muscle relaxants, PT, spinal injections (epidural, nerve block, cortisone shot) for Inflammation reduction & pain relief

Discectomy

• Removes herniated portion of NP that bulged through AF → relieves pressure on spinal nerves

• Most common, less invasive, short recovery period 2-4 weeks

• Posterior incision for lumbar

• Anterior for cervical

Laminectomy

• Removes part or all of lamina (bony arch in vertebrae) to relieve pressure on spinal cord/nerves

• Used when discectomy fails sometimes used together

• Longer recovery period 4-6 weeks

• Sometimes remove whole spinous process as well

ACDF Anterior Cervical Discectomy & Fusion:

• Used to avoid injury to nerves with brain and spinal cord

• Used when disc damage is in the front of the spine or multiple fusions are needed

PLIF Posterior Lumbar Interbody Fusion (ALIF):

• Lumbar and thoracic herniation

• Used if disc damage is easier to access posteriorly to avoid organs and muscles

• Restore the height of a disc

• Can be done anteriorly depending on location

Artificial Replacement

• Maintains normal spinal mechanics → prevents further damage to other discs

• Faster recovery → no bone fusion

• Long-term pain relief

eDAPS: Endplate-modified disc-like angle ply structure

• Designed to mimic natural discs

• Made of hydrogel seeded with cells between polymer endplates

• Research has shown that they have maintained compressive strength, biocompatibility, and mimic native motion and function long term

• Rejection rate is down and motion is up

Cobb angle

A measurement used to assess the severity of scoliosis, taken from the two most tilted vertebrae above and below the apex of the curve.

Scoliosis

A sideways curvature of the spine that can occur in different forms, including idiopathic, congenital, and neuromuscular.

Meningocele

A type of spina bifida where the meninges protrude through a gap in the spine.

Myelomeningocele

The most severe form of spina bifida, where the spinal cord and nerves are exposed.

Folic acid

A vitamin crucial for preventing neural tube defects, recommended at a daily intake of 400mg during pregnancy.

Adam’s Forward Bend Test

A physical examination used to identify scoliosis by observing rib cage prominence when the patient bends forward.

MRI

Magnetic resonance imaging, a common diagnostic tool used to visualize herniated discs and associated nerve pressure.

Neurological issues

Complications associated with spina bifida, which may include learning difficulties and Chiari II malformations.

Epidural

A type of spinal injection used for pain relief in individuals with herniated discs.

Vertebral body tethering

A surgical procedure for scoliosis that involves placing screws on the outside of the spinal curve and tensioning a cord to slow growth on the curved side.