Is disc protrusion the same as disc Herniation? You will find this answer and everything you need to know in this article.
Degenerative disc disease is a progressive condition that is part of aging. It is a contributing factor for low back pain and may cause other conditions.
Although there is an influence of genetics on the development of this disease, occupational and mechanical influences play a significant role. Within this article, you will find answers to some of the most common questions about this disease. Among these, you will find items like the difference between a protrusion and a herniation and which is worse.
After reading this article, you will have critical insights about degenerative disc disease, its symptoms, complications, and treatment. Therefore, please continue reading this article to get pearls on this topic by a doctor’s hand.
What is an intervertebral disc?
Vertebral column or spinal column is the central axis of the skeleton in all vertebrates. It provides attachments to muscles, supports the trunk, and protects the spinal cord. The vertebral column has several types of vertebrae, depending on the portion.
The cervical spine has 7 vertebrae; the thoracic spine has 12 vertebrae; the lumbar spine has 5 vertebrae. Finally, there are 5 sacral vertebrae and 4 coccygeal vertebrae.
There is an avascular structure between the vertebrae that allow the spine to be flexible, provides a shock-absorbing effect, and prevents the vertebrae from grinding together. These are the intervertebral discs. There are 25 of them, seven cervical, 12 thoracics, five lumbar, and one sacral, and account for about 33% of the spine’s length.
These discs consist of three major components. The inner layer is the nucleus pulposus. The outer layer is the annulus fibrosus and the cartilaginous endplates that anchor the discs to adjacent vertebrae.
Moreover, these discs serve several vital functions in the realms of structural support and movement. Within the disc, the components serve different purposes.
For example, the nucleus pulposus distributes the hydraulic pressure through the intervertebral disc. As it has high water content, the nucleus pulposus can disperse the forces from one specific point to the entire structure.
On the other hand, the annulus fibrosus serves to encircle the nucleus pulposus providing structure to its gelatinous form. It can also resist torsion, flexion, and extension movements of the spine.
The spinal discs allow the spine to be a supportive and flexible structure. They provide separation and connectivity between vertebrae and counteract forces that act to lengthen or compress the spine. Finally, they also sufficiently separate the vertebrae to allow spinal nerves to exit for fulfilling all their essential functions in the body.
Is a disc protrusion the same as a herniation?
To establish the difference, it is essential to first define how the physicians see the discs when they make a diagnosis through a Magnetic Resonance Imaging or MRI scan.
The healthy spinal disc has a normal shape, no signs of disc degeneration. It maintains itself within the boundaries of the disc space. To make an assertive diagnosis, physicians divide the spinal disc into quarters, and each quarter represents 25% of the disc.
A disc herniation is, by definition, a displacement of disc material that involves 25% or less of the disc circumference. Disc herniations can be further subdivided into protrusions and extrusions. In a protrusion, the herniated disc possesses a sizable connection to the disc space. In extrusion, a large amount of disc material comes out of the disc, and its connection is through a thin portion.
Disc herniation involves the nucleus pulposus. It is significant as it may compress an adjacent spinal nerve. The herniated disc affects the nerve in direct correlation with the inferior vertebrae causing nerve compression.
For example, if there is a herniation between the 4th and 5th lumbar vertebrae, the herniated disc affects the 5th lumbar vertebrae nerve root. The most common site of disc herniation is at L5-S1, the lower back. This may be due to the thinning of the posterior longitudinal ligament towards its lower end.
Nonetheless, these are descriptions of disc-shape and do not match-up with pain or severity levels. These disc herniations can cause back or leg pain. Due to the nerve compression patient can feel nerve pain, numbness, or muscle weakness. And even if a disc herniation is not compressing a nerve, they can cause pain by generating a strong inflammatory reaction.
What are the symptoms of a disc protrusion?
A disc protrusion can happen in any part of the spine. Whether the neck or the lower back, the symptoms are almost the same, but with slight differences. However, this disease often produces no symptoms at all, and people may not know they have a herniated disc. The following list includes symptoms depending on the location of the herniated disc.
The cause of the pain in the lower back is a lumbar herniated disc. This leads to the following symptoms:
- Sciatica: It is the name that receives the pain that goes from the back to the buttocks, legs, and feet. This is due to the nerve compression that causes the herniated lumbar disc. Nonetheless, back pain might or might not be present at all.
- Tingling or numbness in the legs or feet.
- Muscle weakness due to nerve compression, which can cause the patient to stumble or affect the ability of the patient to stand up or walk.
Neck symptoms have a direct correlation with a cervical disc herniation, and this can lead to cervical spondylosis. It is an area with more symptoms due to the high volume of nerves in a tiny space. The symptoms are the following.
- Neck pain: Due to the nerves’ compression, it happens especially on the back and on the sides of the neck. The pain might increase when bending or turning the neck. This is a pain that patients describe as sharp or burning.
- Pain near or over the shoulder blade.
- Pain that radiates to the shoulder, arm, hand, and fingers. This can happen when the patient sneezes, cough, or move into certain positions.
- Numbness or tingling in the arms and hands.
- Muscle weakness that may lead to an inability to hold or lift items.
An intervertebral disc location that occurs in the mid-back has vague symptoms. This particular condition might induce pain in the upper back, lower back, abdomen, or legs. As well it may lead to numbness in one or both legs.
How serious is a disc protrusion?
The seriousness of the disc protrusion depends on the grading or staging of the condition. Disc protrusions also have herniated nucleus pulposus in different grades, which, if severe, may lead to further complications. The disc protrusion has four different stages of the disease, which are the following:
- First: Disc protrusion.
- Second: Disc prolapse.
- Third: Disc extrusion.
- Fourth: Disc sequestration.
The first two, protrusion and prolapse, are incomplete herniations while extrusion and sequestration are complete herniations. Also, the first two may not cause any symptoms on patients as the nucleus pulposus is still within the annulus fibrosus.
However, the extrusion and sequestration already have leakage of nucleus pulposus. For a better understanding, imagine the disc tissue is a jelly donut. The annulus fibrosus is the dough of the donut, and the jelly is the nucleus pulposus. Now imagine the donut has a hole somewhere, and you press down. The jelly will squirt out of it like the nucleus pulposus from the disc in the spine.
When the herniated nucleus pulposus touches a nerve root, pain begins and receives the name of radiculopathy. If it presses the spinal cord, it receives the name of myelopathy, and it is a more severe condition. Nonetheless, the herniated disc is a condition that can heal over time. Still, it can become a serious condition as it can be a disabling condition. A doctor should perform imaging tests asides from a physical examination to evaluate the severity of the disc herniation.
Which is the worse, bulging, or herniated disc?
A herniated disc is a condition in which there is damage on less than 25% of the disc tissue. It has subtypes that include the protrusion or extrusion and the amount of tissue that keeps the connection to the intervertebral disc.
On the other hand, a disc bulge is similar to the disc herniation. There is a significant part of the disc that displaces beyond its normal boundaries. It involves a displacement equal to or more than 25% of the disc tissue. Interestingly, even though a bulging disc shows a displacement of more significant portions, they are less likely to be painful than disc herniation.
Herniations also receive the name of a ruptured disc. This is because the annulus fibrosus, if severe ruptures, allowing the nucleus pulposus to slip out with the pressure and causing pain. By knowing this, a herniation can be more severe than a bulging disc. It has more chances to develop further complications.
Also, a bulging disc can similarly become a herniation as the pressure inside the intervertebral disc has a wider distribution. Still, it damages the annulus fibrosus leading to a rupture of it.
What are the complications of lumbar disc disease?
Complications for a lumbar disc herniation happen when patients avoid or prolong treatment for too long. When this happens, the lumbar disc protrusion can become a chronic condition that may interfere with daily life activities.
Within the spine exists the spinal cord, a structure from which all the nerve roots are born, and it ends in a structure that resembles a horsetail whose name is cauda equina.
The spinal cord is a susceptible structure that, if it receives damage, it can yield troublesome consequences. Disc injury usually does not affect the spinal cord. Still, if the disease does not receive treatment, it can reach it and develop a more severe stage of the disease.
Severe lumbar disc herniation may lead to permanent nerve damage. However, rare cases in which a disc herniation can compress the entire spinal canal, including all the nerves of cauda equina. Also, there are rare cases in which emergency surgery is to avoid permanent weakness or paralysis. There is a specific complication from this particular disease that can affect the patient in various ways.
Cauda Equina Syndrome
It is a rare condition that exists when the lumbar disc herniation or other pathology succeeds in compressing the nerve roots of the cauda equina. This causes certain nerve impulses can be cut off and does not get to the receiver. At the end of the spinal cord, the individual nerve roots provide motor and sensory information to the legs and pelvic organs. The following symptoms are red flag symptoms and may indicate Cauda Equina Syndrome.
- Severe low back pain
- Muscle weakness, loss of sensation, or pain in one, or more commonly both legs
- Recent onset of bladder dysfunction (urinary retention or incontinence)
- Saddle Anesthesia (Inability to feel anything in the body areas that sit on a saddle, like inner thighs, back of the legs, and around the rectum.
- Recent onset of bowel incontinence
- Recent onset of sexual dysfunction
How is disc protrusion diagnosed?
Several causes may produce pain in the back. When visiting the doctor, he may ask for several imaging tests to discard other possible causes. Similarly, the doctor may perform a complete history asking since when the symptoms are happening, a full physical examination and familiar history. The imaging tests that the doctor may ask are the following.
- X-ray: It is a test that applies radiation to produce a picture of a part of the body. This particular case can show the structure of the vertebrae and the joints’ outline. The doctor asks the spine x-ray to search for other potential causes of pain, such as tumors, infections, and fractures. However, a disc herniation will not appear on X-ray.
- Computerized Tomography (CT scan): The CT scan gives the doctor a new point of view, aside from the X-ray. With the CT scan, the doctor can see the shape and size of the spinal canal, its contents, and its structures.
- Magnetic Resonance Imaging (MRI): This imaging test is the Gold-Standard, which means this is the best and most common test for diagnosing a herniated disc. This test produces a 3D image of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, surrounding areas, and enlargement, degeneration, and tumors.
Other tests like the Myelogram use a contrast liquid that allows the doctor to see the spinal cord and Electromyogram. However, with the advance of technology, these are tests that are not so common, and its use is very infrequent.
How do you treat a disc protrusion?
The initial treatment for a disc protrusion is usually conservative and nonsurgical, which means no surgery. The doctor may advise the patient to maintain low, painless activity levels for a few days to several weeks. This allows the inflammation within the intervertebral disc to decrease relieving the symptoms.
Nonetheless, resting in bed can be counterproductive. It does not allow the spine to perform its natural disc mechanics who can help reduce the herniation.
The doctor may also include medicines in this treatment; the most common are nonsteroidal anti-inflammatory medication, but only if the pain is mild to moderate. These medications include ibuprofen or naproxen. They help to relieve pain, inflammation, and stiffness, allowing an increase in mobility and exercise.
Doctors may indicate physical therapy, as well. In combination with the doctor’s diagnosis, the therapist dictates a specific treatment for patients with disc protrusion. Therapy includes pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation, and stretching exercises.
The goal is to improve core strength, flexibility, and endurance to enable the patient to engage its daily life activities. The exercises relieve pressure on the nerves and improve circulation.
If the pain is severe, the doctor may be considered an epidural steroid injection or spinal injections. It is an injection that the doctor performs using a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation. This might reduce swelling and inflammation of the nerve roots, allowing for an increase in mobility.
Does a disc protrusion require surgery?
It depends. A doctor may recommend performing a surgical intervention if conservative treatment options, such as physical therapy and medications, do not reduce or end the pain. However, very few cases with a disc protrusion eventually need disc surgery. Doctors shall discuss with the patient the possibility of surgical treatment to determine the proper procedure. As well as any other surgery, the doctor considers the patient’s age, overall health, and other issues.
The case varies from patient to patient. The doctor will perform an analysis of the benefits of this surgery against its risks. Although many patients report significant pain relief after spine surgery, there is no guarantee that the surgery might really help. There are cases as well in which surgeries might have complications that will affect the patient’s daily life, which can be counterproductive. For a doctor to consider the patient as a candidate for surgery, he must have one of the following conditions:
- Radicular pain that limits normal activity or impairs quality of life.
- Progressive neurological deficits develop, such as leg weakness and/or numbness.
- Loss of normal bowel and bladder functions
- Difficulty standing or walking
- Medication and physical therapy are ineffective
- The patient is in reasonably good health
In any surgery, there can be complications. When surgery is near the spine and spinal cord, these complications can be very serious, involving subsequent pain and impairment and additional surgery. Here is a list of the complications that can happen during spine surgery:
- Spinal Cord Injury: Any time a surgeon makes a procedure on the spine, there is a risk of injuring the spinal cord. This can lead to serious injuries to the nerves or the covering of the spinal cord, the dura. Damage to these nerves can cause paralysis in certain areas and not others depending on the spinal nerves that receive the injury.
- Persistent Pain: Some spinal surgeries can be unsuccessful. It is one of the most common complications as it may not get rid of the pain. In some cases, the pain may even increase. Have pain on the days after the surgery is normal, but experiencing chronic pain is a sign that the patient should talk to his doctor.
- Sexual Dysfunction: Following the idea of the spinal cord injury, some nerves connect the brain to the pelvic region. If one of those nerves receives a direct injury, it can cause sexual dysfunction.
- Hardware Fracture: In many types of spinal surgeries, there is hardware like metal screws, plates, and rods that hold vertebrae in alignment while the surgery heals. Sometimes, before the patient improves, the hardware can either break or move from the correct position. If this occurs, the patient may require a second procedure to remove or replace the hardware.
- Anesthesia complications
- Blood clots
However, these are complications that the surgeon will fully explain to the patient and will give a list of pros and cons of the procedure along with a list of recommendations.
Can a disc protrusion heal itself?
Yes, disc protrusion can heal itself depending on the severity of the lesion and the care that it receives. Several studies show that spontaneous regression of the disc protrusion is possible, and several factors intervene in this process. However, these are only theories and hypotheses. Doctors and scientists do not clearly know why the disc can spontaneously make a regression.
The first theory states that the protrusion can retract back to its original state into its parent disc. This happens due to natural disc mechanics. Some studies and models support this theory as natural disc mechanics may allow the disc to come back to its original position with proper rest.
The second theory says that it may be due to a dehydration process. The composition of the intervertebral discs asides from collagen is mainly water, allowing the herniated disk shrinks in size as the body reabsorbs the water over time.
The third and last theory says it may be due to an immune reaction. The herniation into the epidural space causes an inflammatory reaction. It results in the absorption of herniated disc by enzymatic degradation. The body recognizes the portion of the disc that has foreign material and attacks it.
The thing is that all of these theories may be correct and may work simultaneously to induce the regression of the herniation. Nonetheless, not all of the herniations may resolve completely. The injuries with the most percentage of spontaneous regression are the sequestrations with over 90% of regressions. On the other hand, the injuries with less percentage of regression are the disc bulges. Only over 10% make a spontaneous regression.
How long does it take for a disc protrusion to heal?
The healing time of a disc protrusion can be very variable. It depends on the type of herniation and the care that it receives with the conventional treatment. A common mistake is that patients with this condition stay on the bed, and they do not know that it can be counterproductive.
On average, a disc protrusion can heal in 4 to 6 weeks if the patients follow the treatment. However, it can get better in a few days, depending on the severity of the herniation and the location.
There are cases in which the disc protrusion does not heal completely, or it can happen again and again. In these cases, the patient should visit the doctor to have a full examination and make an assertive diagnosis, but these cases are not so common.
It is important to remember that the physical activity and medications that reduce inflammation will help the healing process and the herniation regression.
Can you prevent a disc protrusion?
Yes, there are several things like healthy lifestyle habits that can help prevent disc protrusion; here is a list that can help.
- Exercise: Doing regular exercise is an important factor that can help to prevent disc protrusion. Exercise may help to strengthen the trunk muscles, which can stabilize and add support to the spine preventing disc herniation due to an abnormal movement.
- Maintain a good posture: A good posture is vital as it can reduce the pressure on the spine and discs. Lifting heavy objects or sitting for particularly long periods with the proper position can help relieve the pressure.
- Maintain a healthy weight: Having overweight or obesity can add more pressure to the spine and discs. This makes them more susceptible to further herniations.
- Quit smoking: If the patient smokes, the recommendation is to avoid using any tobacco products. This is because smoking lessens the oxygen supply to the disc, causing them to break down more quickly.
Do you are having symptoms?
This tool is a degenerative disc disease symptoms checker. It gathers the most important signs, symptoms, and risk factors for developing the most common problems in the spinal column. It is free and would only take a few minutes to use it.