Spinal Disc Herniation: Clearing Up the Confusion
Many different terms are used to describe a disc herniation. Sometimes they are called a bulging disc, protruding disc, torn disc, slipped disc, ruptured disc, or collapsed disc. The list is long, so one can understand how there might be confusion surrounding this type of injury. However, understanding exactly what makes up these injuries, and how protrusions differs from extrusion, can clearly be explained.
A disc herniation injury occurs when the outer wall of the soft cushion (the spinal disc) between the spinal vertebrae ruptures. A portion of the disc’s inner gel then herniates—which means to push outwards—against the spinal cord and/or the spinal nerves. It’s this pressure on the spinal nerves and cord that causes the pain symptoms that are typical of a disc herniation injury.
All types of disc injuries can occur during an automobile collision, or after other traumatic events like a slip and fall. These injuries create varying problems and varying degrees of pain in each person. However, most people with a herniated disc or some other type of disc injury can all agree that they are painful. This is due to the fact that the spinal cord and the spinal nerves are very sensitive. They have to be, in order to carry all the information to and from your body. Every time you rub your fingers across suede, stub your toe, or wave goodbye, your spinal cord and nerves are responsible. They transmit and receive everything from big muscle movements to tiny, minute feeling.
One of the problems with diagnosing and trying a personal injury case involving a herniated disc is how subjective the idea of pain can be. Each person is affected differently. On a pain scale from 1 to 10, one person could be experiencing a level 4 and the other a level 9, even when they appear to have the same level of disc herniation.
Sadly, injuries to the disc and other soft tissues in the musculoskeletal system are often a permanent-type injury. While treatment is available which may be very effective at mitigating the pain symptoms, oftentimes the injured party is never exactly as they were prior to the acute injury. Following a traumatic injury like this, it’s best to seek the advice of a qualified medical provider and to speak to a personal injury attorney. This way, you get the care you need and you are not stuck with the financial responsibility of someone else’s negligence.
Disc Protrusion vs Extrusion
When a disc herniates, it can do so in two different ways. The difference is minor, but it is still worth noting which is which. The basic idea is that a protrusion is the first step towards extrusion. As the inner gel of the spinal disc starts to herniate through the outer wall, it protrudes. If it continues to push through the wall until a good portion has leaked out, then it becomes an extrusion.
Disc protrusions are commonly called disc bulges. Disc protrusion occurs when the spinal disc and associated ligaments remain intact, but form an out-pouching that presses against the spinal nerves. This protrusion of the disc may push against the damaged fibers of the outer ring, but it mostly stays within its confines.
The pain from a protrusion can sometimes disguise itself as other sources, since the nerves (and the pain) radiates out to other areas. The most common nerve pain associated with these conditions is sciatica. Pressure from the damaged disc on the sciatic nerve can often cause an ache or sharp, shooting pain into the buttocks and down the back of the leg. Numbness, tingling, or generalized weakness in these areas can also occur. Paresthesia is another common side effect of disc protrusion. This is when a tingling, pricking, or numbing sensation is present because the abnormal disc is pressing on a nerve. In severe cases, the sufferer can experience symptoms in other areas, such as lack of bladder control or the inability to raise the foot. A disc protrusion is one of the most common causes of back pain.
A disc extrusion occurs when the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the vertebral disc to squeeze out of the annulus enclosure. It then breaks away from the fibrous enclosure and pushes out beyond the disc and the supporting ligaments. In other words, a disc extrusion occurs when the nucleus leaks out. [See the image below]
The reason for the pain is really quite simple, both in protrusions and in extrusions. As the inner material causes a bulge or actually leaks out, it comes in contact with one or several of the surrounding spinal nerves. This bulging or extruding then places a slight amount of pressure on these nerves, causing the pain. As mentioned above, these nerves are extremely sensitive; so, it does not take much contact to cause a patient excruciating pain.
However, both disc protrusions and disc extrusions can occur without symptoms. If the gelatinous material does not press on any soft tissue or nerves that are nearby, there may be no indication of a problem, nor any pain.
A sequestrated disc—also referred to as a free disc fragment—corresponds to extruded disc material that has broken away from the parent disc and has begun to move away from the site of extrusion. By definition, it is considered a subtype of disc extrusion.
In a disc sequestration, the inner gel extrudes so far through the outer wall of the disc that it breaks off and begins to float freely around the spinal area. Like a protrusion and a extrusion, this can be extremely painful if the freed piece comes in contact with soft tissue or a spinal nerve.
Disc sequestration almost always requires surgery to find and remove to the floating piece.
Diagnosing Disc Protrusion or Disc Extrusion
An X-ray, CT scan, or MRI is needed in order to properly diagnosis whether the pain is from a disc protrusion, disc extrusion, or disc sequestration. These imaging devices create a clear image of the spinal disc, which can be extremely helpful in identifying the shape of the injury.
If pain persists, the use of electromyography (EMG) may be able to pinpoint the exact nerve being irritated. An EMG assesses the electrical activity of a nerve root, which can pinpoint pain, even when a scan does not reveal an exact issue. These tests are not very effective at detecting compression or herniation, but they can be helpful in finding other nerve damage causing pain in the spine. Bone scans can reveal any abnormal bone activity if the problem cannot be found in scans or using an EMG.
Treating Disc Injuries
Disc injuries are often extremely varied from case to case. Because of this, individualized treatment plans are as important as ever in specifically reducing the pain for a specific patient. With that being said, there are some generalities that can be made regarding treating disc protrusion, extrusion, and sequestration. To start with, almost all physicians begin treatment with are known as “conservative” treatments; these are non-surgical options. Conservative treatments can vary from rest to concentrated drug treatments. Conservative treatments may also include anti-inflammatory medications, ice and/or heat, physical therapy, narcotic pain medications, massage therapy, acupuncture, and chiropractics. If pain persists, epidural or nerve block injections may be useful in treating and diagnosing the cause of pain.
It is common for the above therapies to be combined, depending on the situation and how the doctor wants to approach the situation. For example, a patient may benefit from physical therapy, but their pain level is too high to be able to tolerate the movements. In a case like this, medications may be used to lessen or dull the pain so that the patient can undergo the beneficial physical therapy.
There are some cases in which early surgical treatment would be beneficial. These cases often require intervention surgery in order to prevent future or permanent damage. For example, some herniated discs can pinch the nerve root, causing progressive weakness, numbness, and pain in the arms or legs. Having surgery early in the treatment process can slow down any neurological deterioration and allow the nerve to recover.
After four to six weeks of conservative treatment, and with little to no pain relief or healing, your physician may begin to consider surgical options. The three most common surgeries used to treat disc injuries are:
- Spinal fusion
A microdiscectomy is a minimally-invasive surgery in which the herniated portion of the disc which is pressing on the nerve root is removed. This gives the nerve root more space, relieving pressure and allowing the nerve root to being naturally healing. Patients of diskectomies often report some immediate relief as the troubled nerve is no longer in contact with the once protruding disc. Patients also report near immediate relief of leg pain associated with herniated discs (sciatica). However, the affected nerve root and surrounding tissues can take weeks or months to heal completely.
A laminotomy involves removing either part or all of the vertebral arch, also known as the lamina. This is done in order to create more space for the nerve roots to relieve pain. This procedure is performed through a small incision and is thus minimally-invasive. Often times, people experience immediate results as the pressure is relieved from the root. However, the root and surrounding tissues can take weeks or months to heal completely.
The spinal fusion procedure involves permanently fusing together two or more vertebrae using bone grafts and/or metal or plastic screws and rods. This technique relieves pressure by permanently immobilizing the portion of the spine that is causing pain. Spinal fusion may be approached from the front, back, or both sides of the vertebrae.
Artificial disk surgery
Artificial disc replacement surgery is exactly what it sounds like, with the injured or damaged disc being replaced by a prosthetic. The artificial disc is made from plastic and metal and mimics the movement of a natural disc. This surgery was just approved completely in 2006 and is still used sparingly since it can only treat limited types of disc pathology. However, like the total hip or knee replacement, it could be a game changer in orthopedics as the procedure is improved and perfected.
Dolman Law Group
The most important factor to stop pain from protruded or extruded discs is in the diagnosis. Just because an individual has back pain does not mean there is a problem with the disc. Conversely, just because there is a problem with the disc does not mean there will be back pain. If you have been injured in a collision or slip and fall accident, seek quality medical treatment through qualified medical health care providers.
At Dolman Law Group, we will fight on behalf of our clients to hold the negligent party responsible for your injury. Call us today to schedule a free consultation with an experienced personal injury attorney at 727-451-6900.