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I've had an MRI that shows the inner core of my disc at L34 is starting to leak. My doctor mentioned a disc replacement if conservative treatment doesn't work. Can't I just get a patch or something to stop the leak? What about some kind of injection?

The intervertebral disc is made up of two main parts. The inner core is called the nucleus pulposus. It is a fluid-filled gel-like cushion that supports the spine and absorbs the shock with various movements.

The outer covering is called the annulus fibrosus. It holds the nucleus inside and connects each vertebra together. With aging, the disc starts to stiffen and lose its elasticity. Disruption or damage to the disc can result in a herniated disc.

Studies show that degenerative changes within the spine begin in the nucleus. Finding ways to prevent and/or treat this is the goal of many researchers. For now, there are two possibilities: a nuclear implant or disc replacement.

The nuclear implant is a hydrogel pellet surrounded by a polyethylene layer. The pellet can absorb water and swell to mimic the action of the disc. This is how it also restores and maintains the normal disc height.

There are injectable substances. These fill in the space when the disc is removed but not replaced with an artificial disc replacement. The injection is a liquid polymer that cures in about 15 minutes. It's firm but has some give to it.

Not all orthopedic surgeons have been trained to provide all of these options. Some are fairly new treatment methods. Further long-term studies are needed before they can be offered to everyone.

Talk to your physician and see what he or she suggests. Your age, diagnosis, general health, and condition of the spine are all factors in the final decision. Conservative care is always advised first before considering surgery of any kind.

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