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The Injury Clinic - Gallipo has Back Surgery

Wolf reported it earlier this evening.

USC linebacker Chris Galippo will be out about three months following back surgery to repair a bulging disc. This is not the same disc Galippo underwent surgery on last fall but the surgery is similar.

He is expected to return somewhere around Games 3, 4 or 5. The injury occurred about a month ago and doctors recommended surgery, which took place last week. Galippo enjoyed a good spring and starred in the final scrimmage at the Coliseum with nine tackles, three sacks and two recovered fumbles.

A bulging disc, also known as a herniated disc, is more common than you think. It can happen in either the neck or lower back. Many people have bulging disks without any symptoms (asymptomatic), Depending on the severity these cases can go either way most of the time the patient is treated non-operatively but there are a number of different surgical options that also depend on the patient or severity of the injury.

So lets take a look, first some anatomy.

From The Energy Center:

The spine is made up of the following components:

Vertebrae - the bones that make up your spine

Nerves - your entire nerve system runs through your spine

Discs - soft, spongy material or rubbery pads that separates the hard bones (vertebrae), allowing the nerves to run between each bone segment. Discs act like shock absorbers and allow the spine to flex.

The Spinal Canal - a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots.

The natural curves of the spine are vitally important for giving your back strength and resilience. There are 24 vertebrae in your spinal column. The lumbar vertebrae are approximately two inches in diameter reflecting their weight-bearing role. The cervical vertebrae are smaller, since they must support only the head. Facet joints are located in pairs on the back of the spine, where one vertebra slightly overlaps the next. The facet joints guide and restrict movement of the spine. To the rear of each vertebra is a hole and when the vertebrae are stacked up, these holes form a continuous channel which holds the spinal cord.

The spinal cord provides a vital link between the brain and all body functions below the neck. Spinal nerves emerge from the spinal cord through gaps between the main body of the vertebrae and the facet joints. One frequent cause of back pain is a worn facet joint, which can result in a pinched nerve. Therefore, it is very important to keep your vertebrae in good shape.

Outside of a traumatic injury such as contact injury in football, the most common reason for herniated discs is usually a weight problem.

From The AAOS:

A disk herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs.

The symptoms are unmistakable, from WebMD:

Lower Back

Low back pain affects four out of five people. Pain alone is not enough to recognize a herniated disk. The most common symptom of a herniated disk is sciatica—a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve.

Other symptoms include:

Leg pain caused by a herniated disc:

  • Usually occurs in only one leg.
  • May start suddenly or gradually.
  • May be constant or may come and go (intermittent).
  • May get worse ("shooting pain") when sneezing, coughing, or straining to pass stools.
  • May be aggravated by sitting, prolonged standing, and bending or twisting movements.
  • May be relieved by walking, lying down, and other positions that relax the spine and decrease pressure on the damaged disc.

Nerve-related symptoms caused by a herniated disc include:

  • Tingling ("pins-and-needles" sensation) or numbness in one leg that can begin in the buttock or behind the knee and extend to the thigh, ankle, or foot.
  • Weakness in certain muscles in one or both legs.
  • Pain in the front of the thigh.
  • Weakness in both legs and the loss of bladder and/or bowel control, which are symptoms of a specific and severe type of nerve root compression called cauda equina syndrome. This is a rare but serious problem, and a person with these symptoms should see a doctor immediately.

Other symptoms of a herniated disc include severe deep muscle pain and muscle spasms.

Surgical Treatment:

Surgery is appropriate only for people who have specific symptoms and conditions. A decision to have surgery should take into consideration results from diagnostic tests and physical examinations, your response to nonsurgical treatment, and discussions between you and your health professional about your options and expected results.4 Other factors include your age, overall health, the severity of symptoms, and what impact the symptoms have on your life (such as the inability to work). For example, you and your health professional may consider surgery if your job requires a rapid recovery, and there is no time to wait for the herniated disc to heal itself. If you are an older adult, you may be offered surgery if your herniated disc is less likely to improve without surgery because of other spinal diseases.

Disc surgery is not considered effective treatment for low back pain that is not caused by a herniated disc. Disc surgery is also not done if back pain is the only symptom the herniated disc causes.

Surgery Choices

  • Discectomy (also called open discectomy) is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. It is also used for bulging discs or ruptured discs. Discectomy may be the most effective type of surgery for people who have tried nonsurgical treatment without success and who have severe, disabling pain.
  • Laminotomy and laminectomy are surgeries done to relieve pressure on the spinal cord and/or spinal nerve roots caused by age-related changes in the spine. Laminotomy removes a portion of the thin part of the vertebrae that forms a protective arch over the spinal cord (lamina). Laminectomy removes all of the lamina on selected vertebrae and also may remove thickened tissue that is narrowing the spinal canal, the opening in the vertebrae through which the spinal cord runs. Either procedure may be done at the same time as a discectomy, or separately. (Click here to see an image of the surgical approach.)
  • Percutaneous discectomy is used for bulging discs and discs that have ruptured into the spinal canal. It is usually performed under local anesthesia with the patient awake and in the prone position on special pillows.This procedure inserts a special tool through a small incision in the back. The herniated disc tissue is then removed, thereby reducing the size of the disc herniation. This is done with the help of a laser or radio frequencey device. Percutaneous discectomy is considered less effective than open discectomy, and its use is declining. Unless future studies show that this technique is safe and effective, percutaneous discectomy should be considered experimental.