The spine consists of many vertebral bones. Between each pair of vertebral bones is a vertebral disc (soft tissue) that acts as a shock absorbing system. The discs are composed of an outer layer of tough cartilage (annulus) that surrounds softer cartilage (nucleus). An extruded disc is a specific form of a herniated or bulging disk that can put pressure on a surrounding nerve root, and can result in pain that radiates down the back and other parts of the body.
While this condition can be difficult to tolerate, there are different solutions available that can help those suffering with pain from an extruded disc.
An extruded disc is one of the most painful back-related conditions causing patients to seek the help of a pain management doctor.
A disc extrusion is when the soft interior of a vertebral disc (nucleus) squeezes out of the tough cartilage (annulus) that encloses the interior material. It then breaks away from the enclosure and pushes out beyond the disc and supporting ligaments.
Simply put, a disc extrusion occurs when the disc’s interior material leaks through the outer wall and into the spinal column. Extruded discs can be the result of trauma, injury, or age, and are most common in the lower back.
A disc “extrusion” is different from a disc “protrusion.” With a disc protrusion, the interior material pushes against the outer ring, but does not break through the disc’s outer wall. In both cases, part of the disc may press on surrounding nerves and cause pain in the back that may spread down to the leg.
Both disc protrusions and disc extrusions can occur with or without pain. The pain occurs when the disc material presses on soft tissue or nerves in the spine.
What Causes Extruded Discs?
The lower back (lumbar) is the most common area for extruded discs, because of the torque and stress put on it throughout the day. Although designed to reduce the impact on the vertebrae of the spine, the vertebral discs are somewhat fragile. As vertebrae age and degenerate, they become more likely to have issues, such as rupturing and expanding.
Age-related degeneration is a common cause of extruded discs. Years of constant, everyday use and stress on the discs of the spine causes them to weaken. This continuous wear can lead to tears in the exterior wall of the disc, making it easier for the inner material 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 weaken spinal discs. Also, repeated heavy use may contribute to an extruded disc, which is often the case with athletes and people who sustain frequent injuries due to extreme use of their lower backs.
Other than natural degeneration and injury or trauma, extruded discs can occur from a severe strain on the back, such as when lifting a heavy object or moving too quickly. Also, certain lifestyle habits, such as smoking cigarettes and a general disregard for health, can also cause discs to degenerate.
What Are the Symptoms of Extruded Discs?
The pain from an extruded disc may not occur in a patient’s back, but may be felt in the buttocks, down into the leg, or even the foot. The pain can also feel like a tingling, pricking, or numb sensation (paresthesia).
Perhaps the most common nerve pain associated with an extruded disc is sciatica. Pressure from the damaged disc on the sciatic nerve often causes an ache, or sharp shooting pain into the buttocks and down the back of the leg.
Other symptoms of a disc extrusion include:
Spasm-like pain in the affected area.
Weakness in the region of the lower back.
Incontinence of the bowel or bladder.
Pain in the legs.
The early stages of pain from an extruded disc may first appear as stiffness. As the condition progresses, the pain will radiate to the legs. If the material extruding from a disc makes its way to the spinal canal, it can cause severe pain that can limit the patient’s ability to move.
How Are Extruded Discs Diagnosed?
Like many other conditions relating to spinal discs, a physical examination is often the first method of diagnosing a patient’s pain. The physician may use pressure to determine if there is localized pain in the back. A visual examination also helps find any external signs of inflammation.
If, after the physical examination, an extruded disc is suspected as the reason for the pain, the physician may order diagnostic tests, such as x-rays, a CT scan, or an MRI. If pain persists, an EMG (electromyography), also called a nerve conduction study, may pinpoint the exact nerve causing the irritation.
It is important to note that experiencing back pain does not necessarily mean there is a problem with a spinal disc. Conversely, if you have a damaged disk, you will not necessarily experience back pain.
How Are Extruded Discs Treated?
With proper pain management, an extruded disc can return to normal. Depending on the exact cause of the pain, various combinations of treatment therapies are available.
The first treatments for an extruded disc are conservative. Conservative treatments involve rest and non-prescription, anti-inflammatory medications (NSAIDs), along with ice and heat. With proper rest, extruded discs typically heal without surgery. Discs even have the ability to reabsorb the extruded material with time.
Other conservative treatments include:
A healthy diet.
Low impact exercise.
Medical grade analgesic creams, rubs, and sprays.
Depending on the patient, alternative methods such as massage therapy, acupuncture, and chiropractic treatment may also be helpful in relieving pain. However, if these non-invasive treatments don’t provide relief, there are non-surgical interventional techniques that can help relieve the pain.
Non-Surgical Disc Extrusion Treatments
In more severe cases, non-surgical treatments may be necessary, especially if the pain affects a patient’s quality of life, or if the patient has not responded to other treatment options.
For treatment of extruded discs associated with severe pain, a patient may require:
Injections of steroids or an anesthetic. These injections can help reduce the symptoms of nerve root compression, along with the associated pain and inflammation caused by an extruded disc.
Radiofrequency ablation. This is a process of using an electrical current to deliver heat to targeted nerve tissues. The heat can impair or destroy the nerves in question, leading to semi-permanent relief of pain.
Spinal cord stimulation. An implanted device near the spinal cord delivers low-level electrical impulses that override the pain signals sent from the affected nerve to the brain. This device can be adjusted directly by the user, through a small hand-held regulator. The procedure requires minimally-invasive surgery to implant the device, but can be a long-term option for managing severe disc extrusion pain.
Most people obtain pain relief from an extruded disc without surgical intervention. However, in some cases, surgery may be the best option.
Microdiscectomy. As one of the least invasive surgeries, a microdiscectomy repositions the disc to its proper location.
Discectomy. This surgery removes disc material to prevent it from pressing on the surrounding tissue and nerves. The procedure is minimally-invasive and can be successful in reducing pain and inflammation.
After surgery, physical therapy may be necessary to prevent future issues, and allow the healing process to progress.
Is It Possible to Prevent Extruded Discs
Proper posture is perhaps the one thing that everyone can do to help prevent disc injury. Also, regular weight-bearing exercise and core exercises to strengthen the abdomen and lower back are a good way to help prevent spinal degeneration. To help protect the lower back, it’s also important to include stretching, and a diet with a sufficient amount of calcium.
There are several every-day activities that can injure the lower back, so it is important to be aware of these factors to prevent them. These are typical daily activities and include things like:
Sitting at a desk for several hours a day.
Overexertion during exercise.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating pain from extruded discs. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.