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This article was originally published in Positive Health issue 65 – June 2001
Last month, I explained why the intervertebral disc (ID) is not like a bar of soap that can slip in and out of its position. Being from Normandy, I prefer, strange as it may seem, to compare the ID to a camembert.
Connoisseurs like their camembert just right. To assess its ripeness they press its upper surface gently with their thumbs. When a camembert is ready to be eaten, it is soft and yields easily under the pressure. At this stage, it is differentiated into a peripheral white rind and a creamy centre. Unfortunately, not everybody is a connoisseur. Some people are all thumbs when testing their camemberts. If this does not pose too great a threat to a young camembert, thanks to its resilience, the same cannot be said about a ripe one. A careless thumb testing will usually damage the latter by breaking its rind and exposing the soft inner part. An over-ripe camembert can even crack and fissure spontaneously – at this advanced stage you have a runny camembert fit to be eaten only by those who can’t tell chalk from cheese.
In my caseous analogy, the rind represents the peripheral part of the ID, called the annulus fibrosus; the soft creamy part, the nucleus pulposus; the thumb, the constant pressure that our IDs have to endure. To put it bluntly, a herniated or prolapsed disc is like a runny camembert!
But let’s come back into the realm of anatomy and have a closer look at the pulpy nucleus, since it is this soft part of the disc that is believed to be the cause of much pain and disability when it escapes from where it belongs. Unfortunately, despite medical imaging, the ID is a part of the body that is not yet fully understood.
In the early stage of our embryological life we had, extending the length of our ‘back’, a strip of tissue called the notochord. During the formation of our vertebrae, the notochord disappeared almost entirely. The remaining part, which escaped obliteration, became the central part of our IDs: the nucleus pulposus.
Apparently, when it comes to the nucleus pulposus we are not all equal but are divided into the haves and have-nots. According to Alexander Walker-Naddell, an orthopaedic and neuro-surgeon, the nucleus is absent in many individuals – their IDs are like camemberts that would be all rind with a hollow space inside! He noted that 90% of the disc-less spines he dissected came from individuals who had had no history of back trouble. From his research, Walker-Naddell concluded that the nucleus “is not an essential part of one’s anatomy, and that the annular ligament which surrounds it is itself the spinal buffer or cushion”. Professor Chevrot, of the Cochin Hospital, goes even further by questioning the existence of the nucleus as we classically know it. According to Chevrot, at around the age of 10-15 years, the annular ligament, or annulus fibrosus, splits into separate layers and reveals a central cavity. This bold concept of the ID does away with a distinctive central pulpy part. The new picture shows only connective tissue combined with a large proportion of water. So, the ID, after all, might not be a compound structure with two distinct parts.
Is the herniated disc therefore only a myth? Is there or is there not extrusion of a gel-like substance during a so-called prolapsed disc? One thing is sure though, the pain from sciatica, often excruciating, is only too real. But is this debilitating pain caused by the extrusion of a blob of pulpy tissue that compresses or stretches the sciatic nerve? Etiopaths (practitioners of a resolutely mechanistic form of manipulative therapy) think not. According to them, the symptoms from the common sciatica cannot be, for anatomical reasons, caused by a herniated disc.
Practically speaking, it matters little if the nucleus exists or not. The important thing is to preserve a healthy ID. To do so, it is necessary to have good use and posture, which will maintain the proper shape of the spine. Let your back muscles shorten through misuse and soon your spine will lose its proper shape. Either the lower back will be frequently rounded, or it will be solidly locked into a hollow shape. Both cases are departures from the normal shape and under these adverse conditions the annular ligament risks ending in ‘tears’ (as in rupture). But what should we do when it has been torn?
A torn annular ligament could well be the main cause of the pain attributed to the herniated disc. The tear provokes a local swelling, which could in turn cause congestion (accumulation of blood) and oedema (accumulation of fluid in the tissues) in the vicinity of delicate structures such as nerve roots and dura (the outermost layer of connective tissue that encloses the brain and spinal cord). A split disc could be compared to a sprain. A ‘sprained disc’ can heal like any other sprain. “Recent studies show that even for patients with a herniated disk, spontaneous recovery is the rule”, says Richard A Deyo, a general internist. But it takes time and requires rest, especially during its acute phase. The best plan of care I know of to hasten healing and to reduce pain is to fast. During fasting, the body uses autolysis, a process that enables it to break down and absorb any undesirable tissues.
It has been rightly said that fasting is like surgery without a knife. The knife or fasting, the choice is yours. But don’t try either at home unless you have proper supervision!
1. Walker-Naddell A and Livesey AE. The Slipped Disc and the Aching Back of Man. JR Reid Publishing Group. ISBN 0-948-78500-4. 1985.