The spine helps to provide the structural support and balance needed for us to maintain our upright posture. This places an incredible amount of pressure on the bones (vertebrae) within the spine, especially during bouts of extreme physical exertion. Luckily, each of the vertebrae which make up the spine are cushioned by special, pillow-like discs which help absorb the shock of daily movement.
These discs are made up of two layers – an inner, softer layer that provides most of the shock-absorbing cushion and a tougher outer layer that acts as a gasket to protect the inner layer and absorb the heaviest wear to the spine.
Herniated discs occur when a portion of the inner layer of the disc is pushed out through a tear or rupture in the tough outer layer. As the outer layer degrades, more of the inner tissue is expelled and the displaced tissue begins creating uncomfortable pressure points throughout the spine. These pressure points upset the nerves of the spine, leading to bouts of pain which increase in severity as more tissue escapes the disc.
People who experience herniated discs can experience relief through physical therapy or medication, but over time, surgical intervention through a discectomy will be necessary to provide long-lasting relief. Additionally, stem cells for herniated discs are a popular way to decrease recovery times from discectomies as well as increase the positive effects of the surgery.
Anatomy of the Spinal Discs
In clinical terminology the spine is divided into three major sections – the cervical (upper), the thoracic (middle), and the lumbar (lower) spine. Each of these sections is made up of several interlocking bones called vertebrae and between each of these vertebrae lies a fibrous disc that helps cushion the pressures of our everyday movements within the spine.
The discs themselves are made up of two parts. The tough outer layer, known as the annulus fibrosus, provides a gasket to keep the soft, gel-like center tissue (nucleus pulposus) from spilling out. In addition to detaining the nucleus, the annulus also helps attach the vertebrae above and below the disc with tiny endplates made up of tough, cartilaginous fibers.
Together these discs help support our everyday movements and act as the body’s major carrier of axial load.
As we age and the outer layer degrades, the inner nucleus can begin to spill out through ruptures in the annulus. When the outer discs rupture and the inner disc spills out, this can lead to bouts of pain, swelling, and reduced flexibility and range of motion. Once a disc is ruptured, it will never fully heal on its own. Medication and physical therapy can be used to help treat and manage the symptoms of a herniated disc, but they will never truly restore its health.
Typically, surgical intervention through a discectomy (removing the disc from the spine) is the only way to get long-lasting relief after a disc has become herniated. If this is the case, recovery can be long, and if the proper care is not taken to assure the surgery is as successful as possible recovery times can be even longer.
As with all health problems, diagnosis is the first step in ensuring the successful treatment of a herniated disc.
Stages of Diagnosis for Herniated Discs
The complexity of surgery for herniated discs is determined by many factors, and each of these factors ultimately determines how long recovery will take. Discectomies may be minimally invasive, requiring only a short hospital stay and the application of routines of medication and physical therapy, or they may be more involved and require more advanced post-surgical intervention.
Before any surgery can be applied though, diagnosis is critical. A routine examination will allow doctors to assess the tissues in the spine and see if more conservative approaches can be taken to help alleviate pain and allow patients to reach their functional goals.
A complete evaluation of the patient’s medical history and a routine physical examination are the first steps in diagnosis. These exams will give the health care provider an idea of possible causes of a patient’s pain as well as help them determine if a herniated disc is likely.
Doctors may also perform a neurological exam to test reflexes, sensation, and muscle strength. These exams eliminate the possibility of a deeper issue and whether or not treatment will be needed immediately.
Once the health care provider has performed these tests, they will move on to imaging to confirm their suspicions. These tests may include:
- X-ray: use small amounts of radiation to produce images of the bones within the body. X-rays are typically preliminary tests to remove the possibility of other back pain causes beyond herniated discs.
- MRI or CT scan: these tests are especially important for herniated disc diagnosis as they can show whether the spinal canal has narrowed – a key symptom of herniation.
- Myelogram: during a myelogram, doctors will inject a special dye into the spinal canal which shows up on a CT scan. The dye spreads through the spine and helps doctors pinpoint the size and location of a herniation.
- EMG: finally, an electromyogram (EMG) helps doctors assess the damage around the herniation to get an idea of how involved the discectomy will be. By placing small needles into various muscles throughout the spine and measuring electrical activity, doctors can evaluate the condition of the nerves within the muscle. If several nerves are affected, the discectomy may be a vastly more complex surgery than if not.
While these tests are important, early detection is perhaps the most critical way to mitigate the risks of a herniated disc. Signs and symptoms to look out for to prevent extensive damage due to herniation include:
- Increase in severity or duration of bouts of pain
- Mobility issues in the back
- Back pain or sensitivity due to changes in the environment – rain, higher elevations, colder climate
- Back pain which interferes with sleep cycles
- Previous injury to the back which did not heal properly
- Muscle weakness
- Tingling, aching, redness, or burning in the affected area
If these symptoms persist and are affecting your everyday functionality, a discectomy may seem like a viable option to return to normal activity levels.
Making the Decision
While your particular discectomy may not be highly invasive, it is still a decision that requires a thorough examination of all of the possible consequences. Additionally, while doctors may be able to recommend a particular treatment, the decision to pursue it is always left to the patient.
Financial status, age, relative success rates, and familial considerations all play critical roles in determining whether or not to apply surgery. If a long recovery period is suspected, this may also play a major role in applying the surgery.
In any case, if surgical intervention is chosen, a patient should take special care in the days and weeks leading up to the surgery to ensure all matters are in order. It is best to talk to the doctor to uncover all the steps which should be taken as well as research online to figure out anything the doctor may have missed.
Herniated Disc Surgery: A Timeline
The trajectory for a specific discectomy varies from patient to patient, but there are critical points every discectomy will have. The following is an outline of these points, and though they may not reflect your exact procedure, they should give you a good idea of what you can expect.
This guideline is intended to help patients in their decision-making process and allow them to understand what they can expect while going through the surgical process. Take these guidelines with caution and be sure to reach out to your doctor with any questions you may have.
- Preparing for Herniated Disc Surgery: Any successful surgery begins with an adequate amount of preparation. These preliminary steps help promote the well being a patient before and after surgery and may boost its success rate.
- Schedule bloodwork: though your health care team will do everything in their power to identify any risk factors before surgery, performing a blood analysis is by far the most important pre-surgery step. Analyzing a patient’s blood will help doctors determine if any outside risk factors might hinder their ability to perform the surgery well.
- Preliminary “travel” processes: Arrange for rides to and from the hospital, update your emergency contact information, request the necessary time off work, and prepare luggage (toiletries and clothes) to last through the days after surgery.
- Doctor’s notes: stop or start taking any medications your doctor recommends. Do not eat in the hours leading up to the surgery. Refrain from alcohol or drug use. Maintain an adequate sleep schedule.
- Research your medications: Inquire which type of anesthetic will be used and see how it will affect you. Ask about which medications your doctor will be prescribing for post-surgical recovery and learn about their side effects.
- Donate blood: in some cases, the surgical process may cause excessive blood loss. While doctors should have stores of donated blood at your disposal, it may be a cheaper, more effective option to donate your own in the weeks leading up to your surgery. Consult your doctor to see if this may be an option.
- Check-in: with all preparatory steps complete, check into the hospital on time to ensure there is adequate time for all pre-surgical procedures and any final checkups the doctors must do.
- The Procedure: Discectomies may last several hours depending on the location of the herniated disc and the health of the surrounding tissues. Surgery may take longer if the patient is older or if they are in poor health.
- First, an incision is made somewhere along the spine. Discectomies can be performed anywhere from the neck (cervical) to the low back (lumbar).
- In an open discectomy, the muscles are retracted and held in place.
- The spinal nerve is then retracted to one side and held in place. This is an especially important step as the spinal nerve is responsible for motor, sensory, and autonomic signals between the spinal cord and the body.
- In a minimally invasive procedure, a small incision is made and doctors use special tools to bore through the muscles and create a tunnel to access the damaged disc. Special tools are used to remove the disc and the tools used to tunnel through the muscles are removed.
- In some cases, a spinal fusion may be performed in unison with the discectomy to help stabilize the spine. While spinal fusion may increase the overall time of the procedure, it may decrease recovery periods. During this process, the doctor uses special equipment to fuse two vertebrae into a single bone. Fusion is rarely needed in cases of herniated discs, but you may want to talk to your doctor to see if it will be right for you.
- Finally, the surgeon will remove the affected disc(s), replace the retracted nerve, muscles, and bone, and sew the incision closed.
- First few hours after surgery: Anesthetic will be applied routinely throughout the first few hours after the surgery. Doctors will monitor vital signs to ensure the surgery was successful.
- 1-2 days after surgery: Recovery for herniated disc surgery is typically short. While regular functionality isn’t immediate, patients will be asked to move within 1-2 days after surgery.
- A physical therapist will be assigned to you and begin a routine of light exercises to ensure that post-surgical trauma is minimal.
- Assisted stretching and light periods of standing and walking may be asked of you during the sessions immediately following surgery.
- In some cases, patients may be asked to perform these light tasks involving the back on the same day of their surgery.
- 1 week after surgery: Patient activity levels will gradually be increased and the patient will be released upon approval by the physical therapist.
- Once the patient is home, they will be asked to follow the routines their physical therapist taught them as well as apply any medication the doctors have prescribed.
- Creams, ointments, and medication should be taken as routinely as the doctors have prescribed and activity levels should be moderate.
- Simple physical therapy such as massage and hot/cold treatments can be applied if medication and rest do not help alleviate post-surgical pain. Consult a doctor if the pain becomes excruciating or if you suffer back injury immediately following surgery.
- 1 month after surgery: Light activities can resume and physical therapy may intensify.
- At this point, the surgical wounds have still not fully healed, but normal activity levels should resume, albeit with minimal pain and discomfort.
- Extended use may cause flare-ups of pain, but these bouts of pain should wane over time until the wounds fully recover.
- 1 year after surgery: By this time the surgical pains should be gone, and normal activity levels should return. While pain and discomfort may be inevitable, these pains should not be so excruciating that they prevent functionality. Monitor any back injuries thoroughly and report them to doctors immediately following signs of excess damage or decreased functionality.
Herniated Disc Surgery and Regenerative Medicine
Taking the time to rest and monitor your post-surgical symptoms during recovery is necessary to prevent further damage to the spine’s discs. Regenerative medicines help boost the body’s natural healing mechanisms and may reduce recovery periods for herniated disc surgery in some patients.
Regenerative therapies, such as cell-based and platelet-rich plasma (PRP) therapy, are injections of processed adult tissue such as blood, fat, and bone marrow that are meant to create an environment suitable for repairing damaged tissue.
At CELLAXYS, we perform both types of regenerative therapies.
- PRP therapy: This treatment isolates the platelets from the patient’s blood plasma. These platelets are then processed in a centrifuge and reinjected into the patient’s injury site. Platelets are the healing components in our body that act as the first line of defense against injuries. They contain 10 Growth Factors, release chemical signals, and produce a sticky web called fibrin to support the development of new tissues in the injury site. A high number of platelets in the injury site means speedy recovery.
- Cell-based therapies: These treatments extract healthy cells from the patient’s adipose (fat) tissue or bone marrow, process them, and then reinject them directly at the site of the surgery to help boost the patient’s healing responses. The procedure is called Minimally Manipulated Adipose Tissue (MMAT) transplant when the cells are harvested from the adipose tissue. If they are taken from the bone marrow, the process is called Bone Marrow Concentrate (BMAC).
PRP therapy is performed within 45 minutes, while cell-based therapies take about 1.5 to 2 hours to complete. Both are outpatient procedures, meaning you can go home after the process. The doctors use live X-rays and ultrasounds to detect the exact transplant location.
By using these therapies in unison, many patients have found relief from post-surgical symptoms and found that their recovery processes take much less time.
If you would like to learn more about how regenerative therapies can help you recover from herniated disc surgery more quickly, contact the CELLAXYS offices today to set up a consultation.