Herniated Nucleus Pulposus

Herniated Nucleus Pulposus

Herniated Nucleus Pulposus

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The intervertebral disc has the function of a ligament,  a shock absorber and a spacer. It is the structure that most connects two adjacent vertebral bodies with each other.   Unfortunately,  it can also be the origin of extreme sciatica episodes when the inner part of the disc becomes a Herniated Nucleus Pulposus.

Like many other Physicians,  I like to use the example of the jelly donut when describing an intervertebral disc.

The outer part,  or the “bread” is a very firm ligament structure called the Annulus Fibrosus (AF).  It is like a woven braided wall  that helps contain the inner component of the disc call the Nucleus Pulposus (NP).

The Nucleus Pulposus is a soft jelly like material that pressurizes the disc,  allowing it to have the shock absorption,  and ligament function.   Early on in life,  the NP has a type of proteoglycan (protein) that draws and holds water.  As we age,  the proteoglycan changes,  so it has less water holding properties.  The lack of water in the NP leads to less water pressure on the disc wall or Annulus Fibrosus,  and will lead to a bulging of the side walls.     I often use another analogy of a car tire.  When the air leaks out, the side walls bulge out.   That analogy is similar to the lack of water content causing the discs to bulge as we age.

Sometimes,  the disc wall,  or Annulus breaks or fissures,  allowing the soft NP to rupture out,  and cause pain by pressing on the nerves.   Chemicals in the NP also can cause inflammation to tissues it contacts,  and therefore,  some will say the NP rupture will also cause a “chemical neuritis” or chemical inflammation of the nearby nerves.

For the past few years,  some researchers have identified a break of the end of the vertebral body,  or the endplate,  that causes the AF to give way, and cause the NP to herniate and cause pain.

HNP’s,  and disc bulges are an expected finding,  and will effect more than 50% of the population by middle age.

While HNP’s can be a very painful experience,  the vast majority of HNP’s become asymptomatic within 3 months.

Spine Surgeons get involved when the effects of the HNP’s do not go away with standard treatments,  or cause significant neurologic problems such as progressive weakness,  and inability to control bladder and/or bowel functions.  As always,  the individual circumstance must be weighed and the risks and benefits of surgical management must be discussed.  Fortunately,  emergency surgery remains rare.  If you have significant pain,  are losing muscle control,  and cannot control your bowel and bladder, stop reading this Blog and call your doctor,  or go to the ER.  For all others,  make an appointment to get an evaluation about your options if you think you have a HNP that is not getting better.

Citations

  • Dower A, Chatterji R, Swart A, Winder MJ. Surgical management of recurrent lumbar disc herniation and the role of fusion. J Clin Neurosci. 2016 Jan;23:44-50. PubMed PMID: 26282154

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

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The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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