An intervertebral disc is located in between the bones (vertebrae) of the spine to provide cushioning support and flexibility within the spine. However, these discs may become damaged and may tear or move out of place. A herniated disc, also known as a ruptured or slipped disc, is a common condition that may occur as a result of gradual wear and tear on the disc or from an injury to the spine that cracks or tears the disc and causes it to bulge or break open.
Patients with a herniated disc may experience pain, numbness and weakness in the affected area as the disc presses on the nearby nerve roots. The location of the affected disc determines the location of the pain. For example, a herniated disc in the lower back may cause pain through the buttock and down the leg, a condition known as sciatica.
Pain from a herniated disc may be worse during activity and then get better during rest. Anything that puts pressure on the nerve, such as coughing sneezing, sitting or bending forward, can cause pain to worsen. If the herniated disc does not touch any nerves, patients may not experience any pain from this condition.
Your doctor can diagnose this condition after performing a physical examination and taking X-ray images of the affected area. He or she will also ask you questions about your symptoms in order to rule out other conditions and confirm the diagnosis.
Treatment for a herniated disc depends on the location and severity of the condition. In many cases, symptoms will improve on their own within a few weeks or months. Patients should rest, use a heating pad and perform therapeutic exercises in order to manage pain, in addition to taking pain medication prescribed by your doctor. Improving your posture may also be effective in relieving pain and helping a herniated disc heal.
Only the most severe cases will require surgery to treat a herniated disc. Surgery is usually reserved for patients whose pain does not improve over the course of a few months. Talk to your doctor about your surgical options if your pain does not seem to be getting better.
Revision spinal surgery is a procedure that takes place on a patient who has already undergone some form of spine surgery. Typically, by three months after a surgery has been completed, any lingering pain is gone. When a patient is still reporting chronic pain beyond this time frame, revision spinal surgery is sometimes considered.
In other instances, factors besides pain can necessitate revision spinal surgery. These may include the removal of scar tissue that has developed around the incision or an improper diagnosis by a previous physician. At times the procedure is warranted because an earlier surgery did not correct the existing problem since it took place at an incorrect site.
Revision spinal surgery may also be related to the reherniation of a disc, infection, hardware failure, non-surgery related spine degeneration, flat back syndrome, instability, adjacent segment degeneration or pseudarthrosis (failure to achieve solid fusion).
It is fairly common for fusion to be the problem that results in a need for revision spinal surgery. Although spinal fusion is performed to successfully treat chronic back pain caused by a number of different causes, approximately 10 to 30 percent of these procedures are unsuccessful. Fusion failure may occur as a result of hardware problems, new spine issues just above or below where the fusion was performed or recurrent conditions such as spinal stenosis or spinal instability.
Revision surgical fusion involves implanting a new bone graft to the affected area, as well as a bone growth stimulator to promote bone formation in some cases. Previous instrumentation placed within the spine may be removed during this procedure to allow for placement of a new graft and to help the bone properly heal.
The decision to undergo revision surgery depends on the diagnosis made after the initial failure. In many cases, the cause of fusion failure is unknown, which can further complicate the decision to undergo revision surgery. Revision fusion surgery is a much more complicated procedure than initial fusion surgery and carries more risks for patients, including tissues not healing well and a higher risk of infection. The decision to undergo this procedure should always be fully discussed between patient and doctor in order to decide what is best for each individual case.
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