Over the course of the years, the volume of the core of the intervertebral discs (the nucleus pulposus) reduces due to loss of moisture. Indeed, over time we become shorter due to this shrinkage.

This is clearly visible on a magnetic resonance image with enhanced sensitivity for moisture containing structures.

Discusdegeneratie

This image shows the lowest intervertebral disc - no longer grey but black, which means that the nucleus has lost its moisture and thus its shock absorbing capability and function. This does not however mean that lower back pain will ensue. This image is perfectly normal and coherent with a normal aging process. However, if the outermost band of the disc begins to show cracks, this can in fact cause lower back pain. Such cracks can also be seen on MRIs and are often the cause of sudden severe lower back pain (lumbago) with significant mobility impairment. The chronic pain these small cracks cause usually starts after we've been up for a while and then increases as we go about our daily activities. As a result of disc degeneration the height of the intervertebral discs decreases, causing the vertebrae to sag a little more on top of each other and excess load to be placed on the small joints (the facet joints) located to the rear in the back. In this case the entire mobile segment between two vertebrae experiences damage. This usually translates into chronic lower back pain which is particularly noticeable on getting up and after long periods sitting, lying down or standing. As soon as patients move around for a while, the pain improves.

All these problems can cause pain, and for each of them there is a specific treatment. In extreme cases they even qualify for surgical correction. Elective surgery treatment is available for each of these conditions separately. However, it is important that doctors make the correct diagnosis in the first place. This is not always simple, and sometimes supplementary examinations such as discography, in which a contrast medium is used to determine the extent of damage suffered by a given intervertebral disc, are required.

Surgical treatment of

  • Damaged nucleus pulposus: The nucleus pulposus in itself can be replaced with another of man-made material. The new nucleus can be introduced in different ways - either via the abdomen, or via the back, or via an incision in the lumbar region. The surgeon makes a small opening in the annulus fibrosus to remove the broken up remains of the original nucleus pulposus. Then the new nucleus, made of hydrogel in a polyethylene jacket and having the same shock absorbing qualities as the original nucleus, is put into place. This surgery can be used only for the lumbar vertebrae.
  • Damaged disc: When both the nucleus pulposus and the annulus fibrosus are damaged to the extent that they cause pain, the entire disc can be replaced with a prosthesis, which tries to imitate the movements of a normal disc, but does not have the shock absorbing functionality of a healthy disc. This new disc can only be placed via the abdomen. This technique can be applied to both cervical and lumbar vertebrae.
  • Damaged segment (disc + facet joints): Currently the only possible procedure is arthrodesis. This means fusing the entire mobile segment. This could be compared to the immobilisation of a broken and painful arm or leg. The application of a small plate or of a plaster cast causes the pain to cease. This is effectively what we do with a worn and painful backbone segment: it is immobilised. Several different therapeutic options are available. In essence the goal is to ensure that no further movement will be possible in the pertinent segment (two vertebrae + the intervertebral disc + the facet joints), resulting in significantly less pain. This technique can be applied to the entire spine. In our clinic, we are constantly testing different techniques to see which would be most suitable for each individual patient.

The results of these studies are announced at international congresses and are published (cfr. scientific publications).

We co-operate with other collegues and biological ingenieurs to create a prothesis for facet joints. In theory, this should make it possible to replace a damaged segment (disc + facet joints) by a disc prothesis + two facet prothesis. Because of this mobility could be restored again entirely. Please note that this is a prophecy and this is not the case in 2004.