Quote from Badlands:You bring up a good point about the "substances" in the disc causing inflammation without mechanical pressure of the disc itself against the nerve root itself.
Contemporary research is looking more into that concept. I was reading a paper online under the search topic of "failed back surgeries" that theorized that the disc proteins are sealed inside and kept from contact with the immune sytem until a herniation occurs. With a herniation the disc proteins are recognized as "foreign" by the immune system and are thus attacked. The resulting inflammation is thereby related to the nerve root irritation.
Historically disc surgeries attempt to remove actual disc pressure from the nerve, but if it's an autoimmune response, and without actual disc pressure on the nerve roots, perhaps some herniated discs are better treated pharmacologically.
This is also the issue I have with discograms. If a needle punctures a disc in the process of injecting dye, isn't more disc protein exposed to the immune system?
I've been thinking about that too Badlands. It really doesn't sound so good to put a needle in the disc. There has been research about possible sideffects of discograms and they have found nothing - but one can wonder how long follow-up they've had on patients? And maybe they didn't know/recognize this effect of nucleus during this sideffect research?
However I should think that the puncture is very small and that the nucleus (beeing the consistence of toothpaste in normal cases) just never gets pushed through the hole.
But then your disc probably isn't healthy if you undergo discogram, so maybe you have nucleus already pushed close to the annulus - and a needle coming in there is just the trick to let the proteins out?
My mind is sure spinning now since I'm about to have a discogram :confused:
About pharmatreatment of leaking nucleus, they are trying that Enbrel injection (antiinflammatory), there has been a lot written about it here.
But in order for the Enbrel to have effect, the nucleus substance must have leaked OUT of the disc as I understand it? For those with contained leaks (IDD) that just goes fron the center of the disc to the annulus this medication is useless?? Since the disc has poor supply of nutrients the Enbrel will never get into the disc (?).
So people with IDD (chronic) really only face the choice of fusion or ADR surgery? Cause what else could be done..