What is Disc Protrusion?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine
The human spine is a very strong, yet delicate, part of the body. Aging, disease, and injury can all affect the spinal column in different ways. To fully understand a protruding disc, let’s gain a better understanding of the spine.
The spine is made up of a series of small bones called vertebra that surround and protect the spinal cord. These vertebrae are held together by ligaments called spinal discs that act as perfectly sized separators to allow for smooth movement and to keep the bones from rubbing together. These sponge-like discs act as shock absorbers for the spinal cord.
The spinal column is habitually moving and under constant pressure. Due to age, stress, disease, or injury, discs can become damaged. At times discs in the spine can extend or protrude from their normal position.
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More About Disc Protrusion
A protrusion occurs when a disc becomes compressed and, as a result, protrudes from its natural space in the spinal column, between the vertebra. This condition is sometimes referred to as a slipped disc. The protrusion can cause severe pain due to the disc extending passed the bounds of the vertebra and creating pressure on surrounding nerve roots.
Disc degeneration is a natural part of the aging process. As they age, spinal discs dry out, losing water and natural internal fluids. As the discs break down, they lose elasticity and are less able to withstand the everyday stress of cushioning the spine.
While the natural degenerative process is gradual, damage can be accelerated by other influences including injury or lifestyle habits. The spinal vertebrae are responsible for supporting the body’s weight. Added weight creates undue pressure on the vertebrae which compress on the discs in the spine. Eventually, this added pressure causes discs to lose elasticity more quickly, change shape, flatten, and “squish” out beyond their natural space within the spine.
Increased risk factors for disc damage include lack of exercise, weight gain, and incorrect lifting techniques. Other health risks such as poor diet, obesity, and smoking contribute to disc deterioration. Impact and injury to the body is also a common cause of disc damage.
Another type of herniation is called an Extrusion. These occur when the tough exterior of a disc develops a crack. In these cases, some of the soft inner core of the disc can leak into the spinal canal. This leak is referred to as Sequestration. It is also common for discs to protrude from the spine in these cases. Cracks in the vertebra can be a natural part of aging. Other times these cracks are the result of a traumatic injury, especially a strong impact to the body or spine itself.
How is a Protrusion Diagnosed?
To diagnose a protruding disc, medical professionals may use both physical examinations and diagnostic tests.
• Physical Examination:
In the physical portion of testing, doctors may use a technique called Palpation. By applying light pressure to the affected area, sensitivity and pain caused by a damaged disc will worsen, indicating disc damage.
• Range of Motion Assessment:
Assessing the patient’s range of motion is another way of testing the spine. Movement testing will usually include bending the neck or torso forward, backward, and from side to side. Additional testing will involve raising each leg independently in front of the body while standing or, while lying down, raising the legs individually and together. Increased leg or back pain during these movements can be a damaged disc indicator.
• Strength Testing:
A damaging disc will also cause diminished muscle strength. Strength testing can consist of holding the arms or legs out to the side or in front of the body. Tremors, atrophy, or other abnormal muscle movements are another indicator of damage.
• Reflex Test:
An old-fashioned Reflex Test, tapping specific areas with a reflex hammer, can also provide results. Little or no normal reflex reaction may indicate a compressed nerve. Pressure on nerves can hinder reflexes in the arms and/or legs.
• Diagnostic Test:
Diagnostic testing is also used to diagnose spinal issues. Diagnostics take the examination to another level and can provide additional useful information. Diagnostics offer an internal examination that aids in determining the exact location of the damage to properly treat the problem.
How Protrusion Disc are treated?
|Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.|
|Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.|
|Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.|
How Much Does Treatment Cost?
Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.
Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.
This past year you have spent on your pain treatment:
Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.
Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.
Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.
Great job! You are spending very little on your back pain. Keep it up!
Equipment Used in Diagnosis and Treatment of a Protrusion Disc
In cases where a physical exam is inconclusive, or the severity of the pain demands it, diagnostic testing will be ordered. A traditional X-ray provides bone structure analysis and can detect other anomalies, but a Computerized Tomography (CT) scan is a better option. CT scans are x-rays that reformat images into cross sections for a better scan. The CT scan may include a Myelogram wherein radiographic dye is injected into the area to provide more detail.
To get an even better look at the spine Magnetic Resonance Imaging (MRI) is used. The MRI provides a more detailed assessment of the spine including nerves, disc alignment, height, and hydration. An MRI is an excellent option to reveal many forms of disc damage.
Before surgical treatment is considered a discogram may be performed to confirm the exact disc and specific damage. In this test radiographic dye is injected into the disc to recreate pain from the pressure of the dye.
In treatment, antigravity devices may be used to release the pressure on the affected disc. Chairs, tables, and hanging traction devices are sometimes used for this purpose.
How Does Disc Protrusion Compare to Similar Conditions?
The proper diagnosis must be made to treat an issue correctly. Various diseases and types of spinal damage exist. We’ve explained protrusions, here are a few other comparable spinal issues.
Degenerative Disc Disease is caused by the breakdown of the discs. Aging causes spinal discs to dry and shrink. This normal wear and tear of the spine can cause arthritis, herniation of the discs, or spinal stenosis.
Spinal Stenosis is a degenerative disease causing the narrowing of the spinal canal. Stenosis creates pressure on the spinal cord and nerves causing pain, numbness, and weakness throughout the body. Leg and arm pain can be caused by pressure near the neck or lower lumbar regions.
Disc Herniations are divided into two major categories: Protrusion and Extrusion.
Protrusion exists when cartilage rings (discs) are protruding. Technically, there is no actual leakage of the contained liquid.
An Extrusion occurs when the outer layer of the disc tears, allowing inner fluid to leak into the spinal canal.
When the disc ruptures, a portion of the damaged disc can protrude, creating pressure on the spinal cord and/or surrounding nerves. Herniation and protrusion are sometimes interchangeable, but if the disc is ruptured and leaking, the issue is technically an Extrusion.
A Bulging disc is doing just that, bulging out of the spine. When comparing a bulging disc to a herniated disc, a larger part of the disc displaces beyond its normal boundaries with a bulge. Medically speaking, there is a less than 25% disc displacement with a disc herniation.
Armed with this information you are now ready to pursue treatment. We can help you move on to a pain-free and healthy tomorrow.
Analogy: Blow-Out vs Flat Tire
A protruding disc is like a flat tire, a slipped disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.
Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a protruding (flat tire) can progress to become a slipped disc (blowout).
Blow-Out = Instant Rupture
Flat Tire = Slow Leak
Life with Spondylolisthesis was low, I worked with lots of pain. Once I arrived home I would have to lay in bed the rest of the day. After surgery, I went on vacation with no wasted time sitting and resting my back! I’m able to practice sports with my children and live life!
I cannot get over how much better I feel. I get up in the morning and able to bend over the bathroom sink to wash and shave my face without any pain.
NAS was above and beyond other healthcare experiences. I wish all medical groups/appointments were this easy!