[hey_look_its_dave]

Hi Stefanie,

You can find a recent discussion at Tierney's "New guy, looking for answers" thread on this New Members board, but I can think of a few things to add.

It seems to me, the decision to do discotomy or not depends on the situation. Shocking - I know!

For example, as you get older your discs dry out (go darker on MRI) and become less likely to continue to bulge after discotomy. If your discs are nice and hydrated, they'll be more likely to bulge out. The guts of the disc is like calamari (rubbery). So hydration is a factor.

The disc is surrounded by a fibrous ring that normally keeps the calamari innards in, but when it tears there is a reduction in hoop strength of the disc, and more heniation is likely. Depending on how much of the fibrous ring is torn, also affects the likelihood of post-discotomy herniation.

Also, it depends on how the disc was damaged to begin with. If you fell, the disc can be fractured inside, breaking the rubbery stuff into pieces that can spit out the tear in the fibrous ring. If it has deteriorated over a long time, it may not be fractured and bits won't be spit out in time (I think....Harrison, correct me if I'm wrong on this)

If there is damage to the innards of the disc it is likely to be a significant cause of pain. If it just dried out over many years and barely bulged and was not fractured inside, it might not be a pain source. A discogram can determine if there is pain from inside the disc. A discotomy will not solve pain originating from the disc ("discogenic pain"). Obviously, if the bulge is pressing on a nerve root, that'll be painful.

Finally, if you've lost a lot of intervertebral disc height, the tissue through which the nerve root passes will be compressed. Any movement will be squishing the nerve root, even though the MRI may or may not show that the herniation is touching the nerve root. I had this situation. They claimed the nerve root pain (sciatica) was due to nerve root scarring because the discotomy removed the lateral pressure from the herniation. Once my interverbral space was restored though, the sciatica improved 90% so far (roughly 2 months post-op). So if you've lost a lot of intervertebral disc space, I would go for ADR. If it's minor reduction AND it doesn't look like the disc will continue to collapse (based on all the crap I mentioned above), then discotomy might be a sensible and conservative approach.

So, basically, it's a freakin' mess to figure out.

Dave