Disc protrusion occurs when a spinal disc partially ruptures, and gives way. As a result, it causes a bulge into the spinal canal. This condition can be asymptomatic, but it can also cause back pain and other symptoms. Currently, there are various treatments available for disc protrusion that can be used according to the level of severity of the condition.
Disc protrusion is a pathology of the spine that can cause pain and other types of discomfort.
It occurs when an intervertebral disc (a structure that acts as a shock absorber between the vertebrae of the spine) moves out of its normal position.
This causes the disc to protrude into the spinal canal (the cavity that contains the spinal cord and nerves) and can cause various symptoms as a result.
What causes disc protrusion?
A disc protrusion can be caused by various circumstances, and sometimes it is not possible to determine the exact cause.
Most often, however, a disc protrusion is due to one or more of the following factors:
Age
Over the years, the vertebral discs tend to lose flexibility and resistance because of the natural wear and tear on these structures, which makes it easier for them to move out of place. It’s part of the process of ageing.
Specifically, the nucleus pulposus (the soft, gelatinous center of the disc) may escape the confines of the annulus fibrosus (the hard ring-shaped structure that surrounds the nucleus).
When the disc protrusion is due to the ageing process, it is called disc degeneration.
Genetics
Some people are more likely to suffer from a disc protrusion due to genetic causes.
Your job
A sedentary job like sitting at a desk for most of the day can predispose you to disc degeneration.
A job that requires lifting very heavy objects can also make you vulnerable to disc protrusion.
On the other hand, professional bus or truck drivers are at a higher risk of experiencing degenerative disc disease at age 40 or younger, because they must lean their body forward repetitively.
Being overweight
Being overweight can overload the vertebral discs and contribute to their degeneration, especially the discs in the lower back.
Smoking
Using tobacco can reduce the oxygen supply to the discs, which leads to their deterioration.
Poor posture
Routinely using poor posture at work or as you go about your daily activities can have a negative impact on the spine.
The discs of the cervical spine, for example, are constantly subjected to tension and stress.
At the same time, insufficient physical activity and weak muscles can contribute to low back pain and neck pain.
Accident or injury
Although it is not the most common cause, any traumatic injury such as a blow or fall can lead to a disc protrusion.
Symptoms of disc protrusion
In disc protrusion, symptoms will vary depending on the location and size of the lesion.
Frequently, in fact, the patient may not even notice any discomfort. This is known as asymptomatic disc protrusion and is usually detected through an MRI.
This is most common when the bulging disc does not compress the nerve root.
There are even studies that have shown that around 40% of people in their 20s may have some degree of asymptomatic disc degeneration. A percentage that rises to 96% in people over 80 years of age.
Other times, however, the disc protrusion does cause symptoms, which can include the following:
Back pain
Back pain is the most common symptom of a disc protrusion.
The intensity of the pain can range from a dull, constant ache to a sharp, stabbing pain.
Sometimes, the pain gets worse when walking or exercising, and may radiate to the arms or legs.
Weakness
The muscles near the disc protrusion may weaken.
If it affects the cervical spine, this feeling of weakness is usually most noticeable when trying to grasp an object.
When the protrusion is in the lumbar spine, the patient may suffer problems with mobility, like a tendency to stumble or lose balance.
Tingling in the extremities
Depending on the location of the disc protrusion, the patient may notice numbness or tingling in the arms or legs.
All these symptoms can have a negative impact on the patient’s quality of life and limit the things they can do.
Loss of sensation
If the protrusion compresses a nerve, it could cause a reduced level of feeling in the affected area.
Types of disc protrusion
Because disc protrusions usually occur in the cervical and lumbar regions of the spine, they are mostly classified in two large groups:
Cervical disc protrusion
These are disc protrusions that affect the vertebrae of the cervical spine. They most often appear at the levels C5-C6 and C6-C7.
Lumbar disc protrusion
These are disc protrusions that affect the vertebrae of the lumbar spine. The most common location for a disc protrusion in this area are the levels L4-L5 and L5-S1.
Disc protrusion or disc herniation?
The difference between disc protrusion and disc herniation is a difference of degree.
In a disc protrusion, the degenerative changes in the disc cause the fibrous ring surrounding the disc to bulge.
In a disc herniation, part of the soft nucleus of the disc escapes through a fissure in the surrounding fibrous ring.
A disc herniation also tends to cause more noticeable symptoms. Primarily, it produces more severe back pain, because the herniated disc sticks out more and is more likely to irritate nerve roots.
How to prevent disc protrusion
The best way to prevent a disc protrusion is by leading a healthy lifestyle.
Above all, take care of your back at work, get enough exercise to strengthen the muscles and mechanics of the back, maintain a healthy weight, and avoid tobacco.
Can a disc protrusion disappear?
A disc protrusion will not go away on its own and can actually progress into a disc herniation.
When you are diagnosed with a disc herniation or a protrusion, it is important to start treatment to keep it from getting worse, as well as to relieve pain or any other symptoms it may be causing.
The treatment for a disc protrusion can be more or less conservative, and will depend on the symptoms it is causing.
Disc protrusion: treatment
Treatment for a disc protrusion will depend on the nature of the lesion, the discomfort it causes, and the impact it has on the person's quality of life.
In general, treatment options fall into the following three groups: conservative or non-surgical treatments, intermediate treatments, and surgery.
Conservative treatments
Conservative treatments are the first line of defense, used to relieve the pain and discomfort caused by a disc protrusion.
Medication
Pain relievers, anti-inflammatories, muscle relaxants, and antipsychotic medication can help reduce pain in the back and limbs.
Exercise
Physical activity is good for your spine.
Not just strengthening the muscles, but also stretching, and other exercises to relieve back pain.
In addition, swimming, Pilates, and yoga are recommended as exercises that are good for back health.
As for whether walking is good for you if you have a herniated disc, the answer depends on the stage of your condition.
Physical therapy
Specialized physical therapy has also been shown to be effective in treatment of herniated discs.
Healthy habits
Making good posture a habit can help reduce back pain. Also, avoid lifting weight or, if you have to, make sure that you do it safely.
Intermediate level treatments
If these conservative treatments fail to relieve pain and other symptoms, there are further, intermediate level procedures that may be recommended.
Epidural infiltrations
Epidural infiltrations consist of injecting steroidal anti-inflammatory drugs (alone or with local anesthetics) in the area around the membranes that surround the spinal cord.
Lumbar or cervical rhizolysis
Rhizolysis is a procedure that uses heat to make controlled damage to the nerve fibers that are the source of the pain.
Surgery
Surgery can be considered if the disc protrusion progresses to a herniation and previous treatments have not proven effective.
Surgery may also be recommended when the pain is severe and muscle strength is impaired to a degree that makes it unadvisable to wait due to risk of further complications.
Surgery can be performed for both cervical disc herniation and lumbar disc herniation.
Surgery for a cervical disc herniation
The first surgical option is usually cervical microdiscectomy. This technique allows the injured intervertebral disc to be removed and facilitates nerve decompression.
An alternative is arthroplasty, of artificial disc replacement (ADR surgery). In this surgery, the degenerated cervical disc is replaced with an artificial implant designed to mimic the healthy natural disc.
The third option, although much less common, is microdiscectomy for cervical fusion.
Surgery for a lumbar disc herniation
In most cases, a simple lumbar microdiscectomy is performed. This involves removal of the hernia tissue and, depending on the case, the partial emptying of the affected disc.
Other options include lumbar artificial disc replacement (ADR) or lumbar fusion.
As with ADR for a cervical herniation, ADR surgery for a lumbar herniation involves replacing the damaged disc with an artificial one.
In lumbar fusion, on the other hand, two or more vertebrae are fixed or immobilized with the aim of keeping them permanently together.
Instituto Clavel, specialists in disc protrusions and disc herniations
At Instituto Clavel, our doctors and surgeons are experts in the treatment of disc protrusions and disc herniations.
If you have any other questions about these spinal pathologies or want to make an appointment with one of our specialist doctors, please don’t hesitate to book an appointment.
At Instituto Clavel, we’re here to help you!
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