what does dessicated actually mean with discs?

[rob_zzz]

When the MRI scans say you have dessicated discs - what does that actually mean? Is there some kind of chemical/structural change inside the discs - or does it just mean the disc height is lost or its bulging - or does it mean they can see that they've dried out or some other affect like that?

thanks
Rob

[mmglobal]

Rob,

It's all of the above, and it's also a chicken and egg question.

Is the disc dehydrated because the chemical structure changed? (You'll hear a lot about proteoglycans in a scientific discussion of healthy vs. unhealthy disc nucleus.) Or, has the chemical structure changed because the disc became dehydrated. Endplates becoming 'clogged' and not passing nutrients will cause it to become dehydrated. Annular tears change the exchange of fluid and nutrients and causes a local anflammatory response... there are many things that work in concert. I believe that there are many processes that may be responsible... some injury... some genetic... some have to do with lifestyle and stresses (like injury, but without the big event... microtrauma over years of pounding.) For most of us it's probably all of the above.

One of the more interesting things about what I do is that I spend so much time in the OR, I've been able to closely examine nucleus tissue in all different stages of degeneration in many dozens of procedures. You would not believe the difference. Also, the nucleus tissue after a variety of procedures (SED, IDET, biologic disc injections, disc prolotherapy and others), all feels different. Very interesting stuff... I'll post more later.... gotta run now.

Mark

[Maria]

My MRIs say dessicated discs L3-L5S1 with L5S1 being the most dessicated and one goes as far as to say fibrotic at L5S1. Dried out... tho Mark gets to see it all, all stages which must be very very cool~ I mean cool to be in OR and learning/seeing all the ongoing stages of the disc's life/demise (and other structures).

Don't have me guys, I used to work in Neurosurgery and have a natural interest such things~

[dshobbies]

Cool, very cool?

For me, the color - blood red - belongs on a canvas. Seeing it in person, moving this and that out of the way, or even describing disc material as crab meat, makes me want to - well, let's just say I have to skim over some posts.

To each his own, or my personal favorite - whatever tweeks your gourd!

Hoping everyone gets the chance to tweek their gourd, Dale

[sahuaro]

I don't know if my gourd's been tweeked but my interest has been piqued!
Mark, please do expand on the difference in nuclear material with the different procedures!

[mmglobal]

Readers under 18 or with a weak stomach should change the channel now. The images we are about to describe may be quite disturbing.

Remember that these are my 'layperson impressions' and what I perceive may be completely incorrect.

I'm very sorry, but the crab meat analogy is very valid. (I did serve crab salad at one of my GPN gatherings, but I don't think Dale was there. Good thing!)

I've only seen a few relatively healthy discs removed. They were in the middle of long constructs with some evidence of degeneration or instability, that made it unreasonable to leave them out of the surgical plan. The difference in appearance of the nucleus material is remarkable. Very white... very fluffy, very moist. (Jokes about balsamic dressing deleted.) In general... just very healthy looking... good structure...

The more and more degenerated... the more those qualities are gone. What was bright white is now dingy looking... cream colored or yellowed. What was fluffy and moist is now stringy, tough and dehydrated. The worse the disc, the stringer and tougher the nucleus material seems.

Discs that have been IDET'ed or Thermal Annuloplastied have appeared to be BBQ'ed. Some of the nucleus and annulus tissue has been cooked. The tissue is much darker... even brown. Fluid from the disc has appeared brown. I've seen one disc that had both treatments and it was the most cooked of all I've seen. (Note that I make no assumptions about the performance of the tissue. It may be that a successful procedure will address pain generators and there is no lasting effect of the bbq'ed tissue. I'm just noting the appearance of tissues I've seen.)

The disc that had the 'disc sealant' was in a relatively young man and not too severely degenerated. The structure of the nucleus material was different from any other disc I'd seen. It was mushy. It had no integrity. It was very moist... possibly some injectant still inside the disc? I don't know, but the appearance of healthy disc tissue was completely gone. (I don't know how this effects the performance of the tissue... I'm just noting that it appeared to be very unlike normal tissue.)

[sahuaro]

Thanks, Mark, for the info. It certainly makes you wonder about the "lesser" procedures. And it sounds like the crab meat analogy is very apt--but you've changed my perception of crab salad forever!