Disc protrusion is a common form of spinal disc deterioration that can cause neck and back pain. Changes occurring with the regular aging process are responsible for disc deteriorations, although an injury might speed the degenerative process. However, a protruding disc may go undetected unless it encroaches upon a nearby nerve.
If you have a disc protrusion then you are suffering from what is commonly called a ‘slipped disc’. In reality, this is a ‘catch-all’ term for a range of medical problems that relate to the ‘discs’ of soft tissue which separate the vertebrae in the spinal column. In medical terms you may be suffering from either a disc bulge (protrusion) or a ruptured disc (disc extrusion or sequestrum).
Discs usually degenerate in stages:
With age, all body parts change, including the components of the spine. Discs dehydrate and lose elasticity. This weakens the disc and makes it more vulnerable to change.
- The first stage following natural weakening may be classified as a disc protrusion, when the disc’s core that is contained within the disc’s outer fibro-elastic wall has begun pushing into the spinal column. Disc protrusions may involve 180 degrees or less of the disc’s circumference.
- The next stage of disc deterioration is often a bulging disc, when the disc’s inner material, called nucleus pulposus, moves further around the disc circumference beyond its normal parameters as it pushes into the disc’s fibro-elastic outer wall, called the annulus fibrosus, creating a bulge. A bulging disc is said to involve more than half (more than 180 degrees) of the disc’s circumference.
- The final stage may be a herniated disc, which means the disc’s outer wall finally tears, allowing the inner nucleus pulposus material to escape containment by the outer wall.
It is important to remember that different health care providers may use terms like “bulging disc,” “disc protrusion,” and “herniated disc” interchangeably, so you may want to ask for clarification if these terms are discussed during your diagnosis.
Where does it hurt?
A disc protrusion or bulge can occur anywhere along the length of the spinal column from the neck to the lower back. The condition may arise in the neck (cervical spine), back of chest (thoracic spine) or lower back (lumbar spine).
Medical professionals always use this terminology to ensure strict accuracy of both description and communication and in order to avoid misinterpretation.
How is a disc protrusion diagnosed?
One of the complications in diagnosing a disc protrusion is that whilst the apparent pain or problem may manifest in one part of the body, the actual cause of the problem can lie in a different part of the spinal region.
This is why medical professionals pay close attention to the symptoms as a first step in evaluating what the problem may be, before adopting more focused diagnostic procedures.
Is the pain in your lower back?
Combinations of pain in the lower back, buttock, groin or leg can arise either from irritation in the disc itself, or when the disc causes irritation of the adjacent nerves. The pain, which when it spreads below the knee (termed Sciatica) occurs when the slipped disc presses on a nerve in the lumbar spine.
This may cause numbness or pins and needles in the leg and be associated with weakness such as “foot drop” (difficulty lifting the toes and foot up) or weakness when pushing off with the foot.
Is the pain in your neck?
Neck pain, headaches and pain in the face, shoulders, arms and hands may be created when the disc protrusion presses on the neck nerves. This may cause numbness or ‘pins & needles’ in the face, shoulder, arm or hand and may also be associated with weakness of shoulder, elbow, wrist or hand movements.
Any one of these symptoms, or a combination of them, can indicate a disc protrusion.
How is the first attack treated?
The major symptoms arising from the first attack generally settle down over the first 6 weeks and half of the remainder will generally settle down over the following 6 weeks. Treatment during this period is focused upon reducing the irritation.
This may include: anti-inflammatory drugs (Steroids or Non-Steroidal Anti-Inflammatory; therapy such as Ibuprofen, Diclofenac or Acemethacin); and Muscle Balance Physiotherapy to correct the posture and maintain mobility.
How are repeated attacks treated?
Repeated attacks or enduring symptoms need more radical treatment and these may be grouped in to three treatment pathways; Conservative Therapy, Conventional Open Surgery and Endoscopic Minimally Invasive Spine Surgery.
To see these diagrammatically, please click here for lumbar treatment pathways and here for cervical treatment pathways(to be amended by Silkmoth)
Conservative therapy consists of Muscle Balance Physiotherapy, injection, Cognitive Behavioural Therapy and coping courses, plus a restricted lifestyle, and the hope that the symptoms will abate over time.
Conventional Open Surgery carries greater risk than conservative therapy and cannot guarantee success. The surgical options are tabulated below and details of these treatments may be explored through the list on the left (to be amended by Silkmoth
Endoscopic Minimally Invasive Spine Surgery has shown encouraging results in over 80% of 4,300 procedures carried out. This includes patients treated for Slipped discs, Failed Back Surgery, Failed Fusion Surgery, Spine Instability, Chronic Lumbar Spondylosis and Back pain, Lateral Recess Stenosis and Axial Stenosis, Spondylolytic Spondylolisthesis and Disc infections.
In addition, our current and yet incomplete survey of patients operated upon 10 years ago is proving surprisingly encouraging.