Disc Protrusion Symptoms and Treatment

Disc protrusions, bulging or herniated discs are all commonly referred to as a slipped disc. A slipped disc is a general descriptive term referring to degeneration or damage to the intervertebral discs. Spinal disc problems commonly lead to back pain with or without Sciatica.

What Is an Intervertebral Disc?

Discs consist of fibrous tissue in an oval shaped form; they act as shock absorbers, separating the vertebrae in the spinal column when there is impact from activity. Each intervertebral disc is composed of a strong outer layer known as the annulus fibrosos this protects the soft, semi-fluid gel like centre called the nucleus pulposes.

What Is Disc Protrusion?

Disc Protrusion diagramDisc protrusion is a relatively common form of spinal deterioration and is often associated with age related wear and tear conditions in the spinal region; although injury and other trauma can also cause damage to the discs. It describes a condition where damage to the disc causes it to protrude/bulge outwards or herniate, coming into contact with nearby spinal nerves as they exit the spinal canal, causing pain and discomfort.

A slipped disc may mean in medical terms, the patient is suffering from one of the following:

 

  • Disc protrusion or a bulging disc

    The disc’s inner gel like centre pushes into its tough outer shell causing a bulge or protrusion of disc content beyond its normal confinement. This bulge can press against the spinal cord or nerve roots as they exit the spinal cord.

  • Disc herniation (disc extrusion or sequestrum)

    This is when a disc ruptures; the outer shell cracks or tears and the inner nucleus pulposes seeps out, compressing and irritating nearby nerve roots or in some cases, the actual spinal cord.

Note: A protruding or bulging disc may not necessarily lead to herniation.

Why Is a Protruding Disc Painful?

central nervous systemThe spinal column consists of vertebrae stacked on top of one another; the intervertebral discs lie between adjacent discs. The spine provides the body with movement and support, but also protects the spinal cord, which forms part of the central nervous system.

The central nervous system consists of the brain and the spinal cord; a spinal nerve root is the point at which nerves leave the central nervous system from the spinal cord, carrying messages and transmitting signals to and from the rest of the body.

The central nervous system is responsible for controlling our bodily functions, including sensations and movement. Irritation or compression of the nerve roots by a protruding disc can produce painful symptoms, these spinal nerve disorders are referred to in medical terms as Radiculopathy. A protruding disc doesn’t always cause pain, some people may have a protruding disc for some time and be completely unaware of it. Pain is only caused when the protruding disc encroaches on nearby nerves.

Disc protrusion can occur at any point along the length of the spine. However, health professionals classify spinal related conditions into three separate areas; the cervical spine (neck region), the thoracic spine (mid back region) and the lumbar spine (lower back region).

Symptoms and Diagnosis

Pain in the Cervical (Neck) Region

If a protruding disc irritates nerves in the neck region, pain may be felt in the neck itself, but it may also radiate to the arms, shoulders and even as far as the hands and fingers. In fact, pain in the arm is one of the most commonly described symptoms as a result of a slipped disc in the neck. A loss of sensations may occur with feelings of pins and needles. Other symptoms include weak muscles in the arm, shoulder and hand.

Pain in the Thoracic (Mid Back) Region

A protruding disc is not a common occurrence in this region; however, when it does occur, a protruding, bulging or herniated disc may compress nearby nerve roots or even the spinal cord itself. Compression of the spinal cord is a medical emergency, that may result in much more serious symptoms such as paraplegia, bowel or bladder incontinence. Compression of the nerve root however, may cause a range of symptoms similar to those of Sciatica. Symptoms can include; pain in the torso, pain in the legs, pins and needles and numbness in the legs, feet and toes.

Pain in the Lumbar (Lower Back) Region

When a protruding disc encroaches on nerves in the region of the lower back, it is commonly termed as Sciatica. Symptoms of Sciatica can cause pain in the lower back but more often than not, the pain radiates away from the back, to the legs, and is felt in the buttocks, legs and feet. Pins and needles and numbness may also be felt down through the legs as far as the feet and toes. The leg pain is often more severe than the back pain and may worsen when sitting for extended periods of time, or during long walks, lying down often relieves the pain. Unusually large lumbar disc herniations can compress the Cauda Equina, a bunch of nerve roots just below the termination of the spinal cord, this condition although rare, is very serious and requires immediate medical attention.

Correctly diagnosing a protruding disc relies on a detailed medical history and physicians paying extremely close attention to the symptoms, as they play a viral role in the diagnosi. Whilst the actual cause of the pain may be caused by a protruding disc in a particular region of the spinal cord, the symptoms may manifest themselves in another part of the body, such as in the case of Sciatica, where irritated nerve roots in the lower back cause pain and disturbances in the legs and feet. After a detailed study of the symptoms, further investigation such as an MRI or CT scan may be needed to confirm the diagnosis.

Common Causes of Protruding Discs

Spondylosis - a term encapsulating various spinal conditions caused by degeneration

Degenerative Disc Disease

A condition associated with Spondylosis, most protruding discs are associated with degenerative conditions naturally occurring with age. As the body ages, bones begin to lose density, soft tissues such as muscles, tendons, ligaments and intervertebral discs become dehydrated losing their moisture content and elasticity; this leaves the discs more prone to damage and herniation.

Poor Posture and Repetitive Movements

Over long periods of time, poor posture can contribute towards a variety of pain related complaints, including damage to the intervertebral discs. Jobs that involve long periods of sitting, such as office jobs, or long distance driving on a regular basis, are frequently associated with disc related complaints. Other repetitive movements such as continually lifting heavy objects or certain exercises, such as weight lifting, can also damage the discs.

Trauma or Injury

Injury from an accident can rupture or fracture vertebrae and may also damage the discs, causing them to protrude or herniate.

Obesity

Being extremely overweight can put a strain on the entire body including the discs.

Treatment

Conservative treatment is usually the first step, as symptoms generally improve in the majority of cases within a few weeks. Conservative treatment involves a combination of pain medication, physiotherapy, bed rest if needed, as well as any psychological cognitive treatment that may be needed to help patients cope with their pain and adapt their lifestyle accordingly. If symptoms persist for longer periods of time and conservative treatments have failed to improve symptoms, then some of the following may be an option:

  • Disc fusion surgery
  • Microdiscectomy to remove protruding disc material
  • Prosthetic intervertebral disc replacement may be used in some cases, such as in the treatment of degenerative disc disease
  • Conventional open surgery

However, there is no guarantee of success from surgery and there are also the associated risks involved.

Pain Management Clinics

These consist of multi-disciplinary teams of pain management health professionals specialising in conditions associated with chronic pain. The team includes; pain management consultants, physiotherapists, surgeons, psychologists and other health professionals; all working together to devise individual programs to suit patient’s differing needs. With the combined use of pain medication, physiotherapy, psychological support and surgery if needed, pain management clinics can not only help improve symptoms but also support the patient in making necessary adaptations to their lifestyle, enabling them to cope with the effects of chronic pain, as well as encouraging them to adopt and maintain an active and healthy lifestyle.

Image credit: Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine.
Image credit: BruceBlaus Via Wikimedia Commons

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