A spinal disc herniation is termed a slipped disc. This is actually a misnomer. Generally, the disc does not slip. Slip disc is a term used describing the soft material, which acts as a cushion between the two vertebrae, protrudes outward beyond a healthy vertebral disc. Medical professionals classify the condition based on the extent of a spinal disc herniation observed during diagnostic procedures. They use several terms like disc protrusion, disc extrusion, and disc sequestration to classify disc herniation.
Often, a herniated disc happens in the lumbar region of the spine. This is because most of the body’s weight is carried out by the lumbar spine. People between 30 and 50 years of age are more vulnerable to this condition because the elasticity and water content of the nucleus reduces with age.
To know the preventive tips of disc herniation, make an appointment with Dr Surya Prakash, a renowned spine specialist in Hyderabad.
The natural history of extruded lumbar disc herniation
A study was conducted on the natural history of extruded lumbar intervertebral discs by a group of experts. The study was performed on some patients with lumbar disc herniation of age from 19 to 57 years. The reduction of the herniated nucleus pulposus (HNP) of the lumbar spine id well explained. The reduction of the extruded nucleus pulposus with time is due to dehydration, resorption by macrophage phagocytosis, drainage of lymphatic, and immunologic reaction. Dehydration of herniated nucleus pulposus (HNP) might play a major role in the reduction of the herniated lumbar disc.
The degenerated disc makes the disc inflexible, smaller, and more vulnerable to tearing of the exterior parts. If one disc degenerates, it may alter the structure of the spine and it’s functions of the lumbar spine, particularly at the segment surrounding the disc.
What happens if the disc material is not removed, how nature or the body eats it up?
When a lumbar disc herniated, the gel-like substance comes called a herniated fragment. The material is mostly made up of water. Initially, it may cause pain as it pressurizes the nerves but over time this water content will be absorbed by the body and as a result, the herniated segment will shrink in size. As it shrinks it doesn’t affect the nerves nearby anymore.
Various Types Of Disc Rupture
The disc rupture classification is based on the extent of damage of the disc’s tough outer part(annulus fibrosus) and the nucleus pulposus – the jelly-like substance located at the center of the disc. The disc may swell and remain intact in some patients, while in other cases, the nucleus may protrude out breaking the annulus of the disc.
Disc Protrusion: This is a type of intervertebral disc herniation where the spinal disc and the ligaments associated with it remain intact, but some soft material from the disc bulges out. The bulge can compress the nerves causing pain and discomfort. A disc protrusion can also progress into disc extrusion or disc sequestration.
Disc Extrusion: Extruded discs or disc extrusion is a type of intervertebral disc herniation where the soft jelly-like material(nucleus pulposus) inside the spinal disc extrudes out completely breaking the outermost layer of the disc. It results in compressing the ligaments and adjacent nerves of the disc, causing lower back pain.
Disc Sequestration: It is like a subtype of the extruded disc. Here the gel-like material completely squeezes out of the nucleus of the disc, which is called a free fragment. The free fragment can migrate to other areas of the disc & vertebrae and aggravate spinal nerves causing pain. Symptoms of this condition are based on where the fragment settles.
A spine surgeon identifies the location and the nature of disc herniation that is causing the back pain. Based on this information, the surgeon determines whether a patient requires non-surgical therapy or surgical procedures to treat the disc herniation.
A slipped disc is one of the leading causes of back pain problems in many patients. Today let’s discuss the symptoms of disc extrusion and treatment for disc extrusion (surgical and non-surgical) for relieving your back pain.
What Causes Extrusion Of A Disc?
Disc extrusion happens in the background of the natural aging process like disc degeneration. Degeneration is the natural wear-and-tear of the disc that occurs over time. Due to sudden exertion or trauma, the nucleus pulposus material is extruded, and this condition is called extruded lumbar disc prolapse. Some other causes of extruded disc include:
- Injury due to car accident or trauma
- A severe strain on the back due to heavy or improper lifting of weights
- Repetitive motion injuries
Mostly extruded discs and other conditions disc-related are due to the natural consequence of the spinal functions over time. People who are obese or excess weight and having a habit of smoking are more prone to extruded disc conditions. It can also result from the genetic history of disc degeneration or a job that involves lifting heavy weights or repetitive motion of the spine.
What Are The Symptoms Of Extruded Disc?
Many people commonly experience extruded disc problems near the lumbar spine or the lower back. When this extruded substance disturbs the nerve root or a spinal nerve in the spinal cord, it results in extreme pain. Though all patients don’t experience pain, the other symptoms include:
- Pain in the lower back, buttocks or groin areas
- Shooting pain in the affected area
- Weakness in the lower extremities
- Loss of bowel and bladder control happens in severe massive disc extrusion causing cauda equina syndrome
Cauda equina syndrome (CES)
Extruded discs can also cause a severe complication known as cauda equina syndrome. It is a medical emergency, and you may experience worsening of the symptoms all of a sudden like numbness inside legs or loss of bowel or bladder control.
The cauda equina is a cluster of nerve roots that sends and receives signals to the legs, bladder, and various other body parts. Cauda equina syndrome occurs when this nerve roots rupture due to herniated lumbar disc. As a result, it may disturb the motor and sensory functions of the bladder and other lower extremities.
If the condition is left untreated, it might cause severe and irreversible health problems like chronic incontinence and paralysis of the legs. For this reason, it requires immediate medical attention and, in most cases, emergency surgery.
How Extruded Discs Are Treated?
In the case of minor disc extrusion, surgery is not necessary because most of the extruded discs heal on their own. However, a spine surgeon would suggest conservative approaches initially to treat extruded discs. Non-surgical treatments include pain medication, epidural or steroid injections, nerve blockers, and more. In some cases, interventional procedures like radiofrequency ablation and spinal cord stimulation show effective results.
Conservative treatment for any type of disc herniation includes:
- NSAIDs like ibuprofen which reduces inflammation
- Topical pain relievers for muscle spasms
- Physical therapy with exercise and stretching
- Relaxation techniques and some other natural remedies for back pain
- Corticosteroids injections are given when a patient is suffering from intense pain
If the disc extrusion progresses, damaging the disc severely, a spine surgeon would consider minimally invasive spine surgery. Microlumbar discectomy is a popular surgical procedure for a Lumbar Herniated Disc. Discectomy is a process of removing lumbar herniated disc material, which is compressing the nerve root or the spinal cord—it best back surgery for herniated disc with lower complications.
It is also called microdiscectomy, where a special microscope is inserted to view the damaged disc and nerves. A small incision is made in the lower back to access the herniated disc. Some special surgical tools are inserted to remove the herniated disc material. The disc needs to be replaced in some patients when it is completely damaged. In some patients, fusion may be done after discectomy to help stabilize the spine.
However, discectomy is recommended only when conservative treatments like physical therapy, medications, or other treatments fail to relieve leg or back pain. It is also done when a patient has the signs of nerve damage like weakness or instability or loss of sensory feeling in your legs. Discectomy procedure can be performed as an open surgery or minimally invasive technique(Microlumbar discectomy).
What Happens If A Herniated Disc Left Untreated?
Long term nature of the condition is most of the time is benign , but in the process it can cause untold suffering and misery to the patient. Avoiding or prolonging the treatment of a herniated disc may lead to severe health complications which can turn out to a chronic condition.
In favourable circumstances the entire extruded and sequestrated pieces can get reabsorbed by the natural process of human healing. But this is a long drawn process and can take a few years to happen.
Another less common possible chronic condition as a result of an untreated extruded disc rupture is saddle anesthesia as a consequence of cauda equina syndrome – this a condition where the compressed nerves cause loss of sensation in your inner thighs, legs, and around your rectum.This is more likely to happen in a acute setting. Chronic cauda equina is a rare entity.
If you experience any back problems, don’t neglect to consult Dr Surya Prakash, one of the best spine surgeons in Hyderabad. He has more than 20 years of experience as a spine surgeon and has performed hundreds of lumbar disc decompression surgeries.