Surgical Battle of the Bulging DiscShooting pain down the leg is sometimes called sciatica. There are many possible causes of sciatica. One of the most common is a bulging disc. The disc is an oval-shaped, soft cushion located between the bones of the spine. Each disc has a center called the nucleus pulposus and an outer ring called the anulus fibrosus.
The disc can be damaged from injury. Or as we age, the disc may start to break down. A damanged disc can begin to pressure on the nearby spinal nerve. Doctors have found four types of disc damage leading to sciatica. All four have a bulging disc with one other feature. The other features include a normal anulus fibrosus, large anular defects, pieces of disc material inside a normal anulus, or bulging anulus with no disc fragments inside.
A recent study at Stanford University School of Medicine has linked these four types of disc problems to surgery results. Patients with a bulging disc and normal anulus have the best result from surgery. Pain from the sciatic nerve is relieved after the disc is removed. On the other hand, patients with a bulging disc and large anular defects have a higher rate of second operations.
The authors of this study say that types of disc herniation can predict the final outcome. Certain types of problems are more likely to herniate a second time. Since imaging studies show the type of damage present, doctors can predict which patients will have the best result with an operation. New methods of treatment can be studied for the less successful types of problems.
Eugene J. Carragee, MD, et al. Clinical Outcomes After Lumbar Discectomy For Sciatica: The Effects of Fragment Type and Anular Competence. In The Journal of Bone and Joint Surgery. January 2003. Vol. 85-A. No. 1. Pp. 102-108.
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