What Are Extruded Discs?
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Over 25% of the population in the United States suffers from lower back pain. There are many components to the lower back, including spinal discs, nerve roots, tendons, and muscle. Irritation of any one of these can cause discomfort ranging from mild to severe. This pain is referred to as chronic back pain if it persists for more than three months.
For patients suffering from chronic lower back pain, approximately 2% of them will also develop a herniated disc.
A hernia occurs when a tissue protrudes from where it is normally located. This happens to a spinal disc when significant wear and stress causes the nucleus pulposus, the disc’s jelly-like center, to push against the annulus fibrosus, the disc’s thick outer wall, as a result of trauma, injury, or age. When the nucleus pulposus pushes completely through the annulus fibrosus, this is referred to as an extruded disc. In extreme cases, sequestrations may occur, which is when the herniated tissue can separate and seep into the spinal column.
The most common part of the spine to experience an extruded disc is the lumbar spine or lower back. When the displaced material comes in contact with a nerve root, spinal nerve, or spinal cord, the extruded disc causes pain to the patient, though not all patients will actually experience pain. Other symptoms of a disc extrusion include:
- Dull aches
- Spasm-like pain in the affected area
- Shooting pain
- Weakness in the region of the lower back
- Incontinence of the bowel or bladder
- Pain in the legs
Causes Of Extruded DiscsA common cause of extruded discs in older patients is degeneration with age. Regular wear on the discs of the spine from everyday use and stress causes them to weaken as we get older. This continuous wear can lead to tears in the annulus fibrosus, making it easier for the inner part of the disc, the nucleus pulposus, to protrude into the surrounding area, causing lower back pain.
Another cause of extruded discs is injury or trauma. A sudden impact or severe damage to the spine or lower back can also weaken the tissues involved. In addition to sudden trauma, repeated heavy use may also contribute to an extruded disc. This is often the cause for athletes and other people who sustain frequent injuries due to extreme use of their lower backs.
Preventing Disc ExtrusionThere are several actions that can injure your lower back, so it is important to be aware of these factors to prevent them in your daily activities. Many of these factors are common in our daily lives, such as:
- Continuous standing
- Sitting at a desk for several hours a day
- Overexerting ourselves during exercise
- Heavy lifting
- Repetitive motions
There are ways to help protect the lower back, including low impact exercises, stretching, good posture, and adding sufficient calcium to your diet.
Disc Extrusion TreatmentWith proper management, an extruded disc can return to normal. Depending on the cause of your pain, various combinations of therapies are available, including:
- A healthy diet
- Low impact exercise
- Warm and cold compresses
- Non-prescription anti-inflammatory medications, such as NSAIDs
By working closely with a pain specialist, you can receive the correct diagnosis for your pain and take the steps to resolve it. A good pain specialist works closely with a team of healthcare professionals, like physical therapists and nutritionists, who can advise you on the best at-home remedies to help relieve your disc extrusion pain. However, if these non-invasive treatments don’t work, they can also recommend interventional, yet still non-surgical, treatments for extruded discs.
Non-Surgical Disc Extrusion TreatmentsIn more severe cases, a more aggressive treatment may be necessary. This may occur if your pain is severe and affects your quality of life, or if it hasn’t responded to other treatment options.
For treatment of extruded discs associated with severe pain, a patient may require epidural injections of a steroid or an anesthetic to reduce pain and inflammation. These injections significantly reduce the symptoms of nerve root compression and the associated pain and inflammation. Epidural steroid injections are considered safe procedures, with very few side effects. They’ve been in use for decades as an interventional pain management technique. The following video shows one of these procedures being performed on a patient.
Radiofrequency ablation involves using an electrical current to deliver heat to targeted nerve tissues. The way this heat is applied can impair or destroy the nerves in question, leading to semi-permanent relief of your pain.
Spinal cord stimulation, on the other hand, works by implanting a device near the spinal cord that then delivers low-level electrical impulses to the affected epidural space. This overrides that pain signals sent from the nerve to the brain. This device can be adjusted directly by the user, through a small hand-held regulator. While spinal cord stimulation does necessitate a minimally-invasive procedure to begin, it’s a long-term option for managing severe disc extrusion pain for many patients. It’s also fully reversible and considered safe and effective for disc extrusion, and other types of pain.
Is Disc Extrusion Surgery Necessary?No, surgery isn’t required for all patients who suffer from disc extrusion. In fact, most people will find relief from their pain without any surgical treatments at all.
If you’re working with a good pain specialist, they’ll always first recommend at-home treatments and rest for resolving your pain associated with a disc extrusion. From there, they may suggest the minimally-invasive injections or treatments mentioned above. However, if you still have severe pain even after attempting these treatments, surgery may be your only and best option.
Disc extrusion surgery is called a discectomy, in which the problem tissue is removed to prevent it from pressing on the surrounding tissue and nerves. This procedure is common, with nearly half of a million discectomies performed each year. The procedure is minimally-invasive and removal of the disc material has been successful in reducing pain and inflammation. The American Academy of Orthopaedic Surgeons notes that surgery results are “generally very good.” Many patients will find pain relief over the first several weeks following the surgery.
Disc discectomy is still a surgery, so it carries it’s own risks. Your doctor will work closely with you to