This article has been revised to provide the most accurate and up-to-date information.
*original publication date: November 12, 2018. Revised January 11, 2023
The Anatomy of Intervertebral Discs
Intervertebral discs are composed of two layers. The center of the disc is called the nucleus pulposus and has a gel-like consistency. The outer ring of the disc is called the annulus fibrosus and has a sturdier, but still flexible structure. Due to injury or degeneration, cracks (fissures) start to develop in the discs from the inside out. During the process of degenerative discs disease, the entire disc can begin to dry out, which can make the entire spine less effective at absorbing forces and may cause the discs to shrink down in height. Because discs lack an adequate blood supply, these disc annulus fissures cannot heal spontaneously. As a result, fissures extend in length and become more numerous over time. The discs themselves can become painful because of this process. A large enough disc annulus crack may allow some of the nucleus pulposus material to escape from the center of the disc and compress a spinal nerve. This is called a herniated nucleus pulposus (HNP) and can cause nerve pain in the legs.
Treatment with Discectomy
A discectomy is a surgical procedure that tries to solve this problem by literally removing the portion of the spinal disc that is injured. This procedure can help to eliminate some of the pain caused by the disc injury, especially that related to nerve pain caused by compression from the herniated nucleus pulposus. However, there are many unintended consequences to this surgical treatment.
A discectomy is an invasive spinal surgical procedure that alters your anatomy from the surface of your skin all the way down to the depth of the disc. The surgery involves cutting though skin, muscles, tendons, ligaments, and bone just to reach the disc. Due to the location of the disc in the front of the spine, a surgeon approaching from the back of your body must sometimes remove portions of the vertebral bone called the lamina in order to successfully access the location of the disc herniation. This portion of the procedure is called a laminectomy. Removing this bone tissue can contribute to spine instability in the future. Depending on the degree to which ligaments, tendons and muscles are disrupted during the surgery, future spine instability can be the result of these factors as well.
A successful discectomy surgical procedure, at best, can remove herniated disc material that is compressing a nerve. This addresses the leg pain, but patients are sometimes left with persisting low back pain. The disc cracks that allowed the herniation to occur cannot be surgically sewn because discs do not have an adequate blood supply to do so. For the same reason the disc cracks will not heal spontaneously. Therefore, a disc that underwent a successful discectomy could herniate again and start the process of pain all over. One study noted that up to 25 percent of patients had a re-herniation of the affected disc. Even if another herniation did not occur, 10 percent of patients had to undergo a further operation to relieve pain. Subsequent discectomies can be even more difficult to perform as well due to the buildup of scar tissue from the previous surgery.
Discseel® as an Alternative, Non-Surgical Option
This treatment option also works to improve back and leg pain stemming from the intervertebral discs, but it is able to do so without surgery. This procedure utilizes a fibrin biologic to help regrow damaged spinal disc tissues, which preserves the discs instead of removing them. By restoring the intervertebral discs, reinjury is less likely to occur and pain management is able to be more effective.
This procedure utilizes an injection directly into the damaged disc with the use of image guidance to ensure accuracy. The fibrin portion of the injection is able to serve as “glue” in the disc, helping to seal off any damage that has occurred in the outer annulus layer, such as tears or cracks. This sealing helps to eliminate future herniations and can reduce pain caused by the original disc abnormalities.
All in all, this procedure works to repair damaged discs by stimulating growth from the inside out and is able to concentrate recovery efforts due to the disc sealing provided by the fibrin. This injection has been shown to relieve pain symptoms relating to disc disorders, and it has a 70 percent success rate on patients who have already undergone a previous procedure to treat their spinal disc issue. This makes Discseel a great alternative to a discectomy.
Sources:
https://www.urmc.rochester.edu/neurosurgery/for-patients/treatments/discectomy.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996348/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922511/
https://drkevinpauza.com/procedures/pauza-disc-treatment.html
