Table of ContentsView AllTable of ContentsProtrusionExtrusionSequestrationSymptomsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Protrusion
Extrusion
Sequestration
Symptoms
Diagnosis
Treatment
A spinal discherniationoccurs when a disc—the soft cushion between two vertebrae—pushes outward beyond the normal boundaries of a healthy disc. Medical professionals use several terms to describe the extent of a spinal disc herniation (slipped disc) seen on anMRIexamination, including disc protrusion, disc extrusion, and disc sequestration.
This article explains how the disc can bulge and remain intact, or the nucleus can leak out from a tear in the annulus. It explains how disc protrusion and other herniations are diagnosed and treated.
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Disc Protrusion
With disc protrusion, the herniation occurs when the spinal disc and its ligaments remain intact but form an outpouching that can press against nerves. Technically speaking, the farthest edge of the herniation measures smaller than the herniation’s origin at the base of the disc.
A disc protrusion can remain as is, but it can also progress into one or both of the following two herniation types. The goal is to reduce the size of the protrusion reaching into the spinal canal.
Disc Protrusion vs. Herniation
The Anatomy of the Cervical Vertebrae
Disc Extrusion
This kind of herniation occurs when the nucleus squeezes through a weakness ortear in the annulus, but the soft material is still connected to the disc.
Your body considers the nucleus material to be a foreign invader, which triggers an immune response and inflammation. This can bring about additional pain and swelling.
As with protrusion, an extrusion can remain as it is, but can also progress to the next type of herniation.
Will Disc Protrusion Heal Itself?Maybe. Disc protrusions and extrusions can improve on their own, or with pain management andphysical therapy. Providers often try conservative approaches for six weeks before considering surgery. Estimates on whether a disc herniation will spontaneously heal include:Bulging discs, 13%Protruding discs, 41%Extruding discs, 70%Sequestered discs, 96%There’s somewhat paradoxical evidence to suggest that the more severe the herniation is in the short term, the higher the chance it will completely resolve.
Will Disc Protrusion Heal Itself?
Maybe. Disc protrusions and extrusions can improve on their own, or with pain management andphysical therapy. Providers often try conservative approaches for six weeks before considering surgery. Estimates on whether a disc herniation will spontaneously heal include:Bulging discs, 13%Protruding discs, 41%Extruding discs, 70%Sequestered discs, 96%There’s somewhat paradoxical evidence to suggest that the more severe the herniation is in the short term, the higher the chance it will completely resolve.
Maybe. Disc protrusions and extrusions can improve on their own, or with pain management andphysical therapy. Providers often try conservative approaches for six weeks before considering surgery. Estimates on whether a disc herniation will spontaneously heal include:
There’s somewhat paradoxical evidence to suggest that the more severe the herniation is in the short term, the higher the chance it will completely resolve.
What to Expect From Herniated Disc Physical Therapy
Disc Sequestration
Disc sequestration occurs when part of the spinal disc not only squeezes out but separates entirely from the main part of the disc.This is also known as afree fragment.
The free fragment can migrate and aggravate spinal nerves (typically moving up, down, or sideways) but there is no way to predict where or how severely.Any symptoms, if they occur, depend on where the fragment settles. Symptoms generally appear in one extremity (one arm for a neck herniation, or one leg for a lower back herniation).
As with extrusion, sequestration can also trigger an immune response to the nucleus material, bringing inflammation to the area.
Ruptured discis not an accepted medical term and suggests trauma when none has occurred. The technical term isdisplacement of disc material.
Herniation Symptoms
The hallmark of disc herniation is pain. Any of the three herniation types have the potential to cause it and other symptoms.
For example, depending on its location, a protrusion can come in contact withspinal nervesjust as easily as an extrusion or sequestration can. The amount of pain and other symptoms will depend on how the nerves have been compromised and can suggest that a painful disc may be getting worse.
Along with pain, herniations can press against the spinal cord or nerves and causeradiculopathy, the neuromuscular symptoms typical of a disc herniation.Depending on the site, these may include:
All that said, it’s still common to have protrusions, extrusions, or sequestrations with no symptoms whatsoever. One review of 33 studies found that 37% of 20-year-olds may have herniations without symptoms, and the number rises with age to 96% of 80-year-olds.
Who’s At-Risk for Spinal Disc Herniation?Spinal disc herniation is most likely in males ages 20 to 50. It also is associated with:Heavy lifting and improper lifting techniqueRepetitive motions, typically at workFrequent driving, with long sitting times placing pressure on the spineSedentary lifestyles (little exercise) and beingoverweightSmoking, which can accelerate spinal disease and degenerative damage
Who’s At-Risk for Spinal Disc Herniation?
Spinal disc herniation is most likely in males ages 20 to 50. It also is associated with:Heavy lifting and improper lifting techniqueRepetitive motions, typically at workFrequent driving, with long sitting times placing pressure on the spineSedentary lifestyles (little exercise) and beingoverweightSmoking, which can accelerate spinal disease and degenerative damage
Spinal disc herniation is most likely in males ages 20 to 50. It also is associated with:
How to Prevent Degenerative Disc Disease
Most terminology surrounding spinal discs are based on measurements, as well as the size and shape of the displaced disc material. While some use the termsbulging discand herniated disc interchangeably, there are clinical distinctions between the two based on these factors:
Bulges also don’t extend very far beyond the normal boundaries of a healthy disc, usually 3 millimeters or less, and generally cause fewer symptoms than herniations.
Magnetic resonance imaging (MRI)is often the tool of choice when trying to assess the discs of the spinal column. However, it has its challenges.
Non-Definitive Findings
Since disc degeneration naturally worsens with age, it’s actually common to find disc abnormalities on MRI tests. This is an issue when working to diagnose a herniation as subtle findings may not be clinically important, but may lead people to invasive or expensive treatments that they don’t really need.
For example, someone may have back pain, as well as a disc abnormality on their MRI, but that does not necessarily mean the two are related. They can be, but presuming the two are related can lead to poor treatment results.
A skilled clinician can help you determine if the disc problem seen on an MRI is truly the cause of your symptoms. It may help to seek a second opinion.
To further complicate matters, the specific typeof disc problem seen on an MRI does not necessarily dictate treatment, which makes next steps uncertain. A healthcare provider must correlate the MRI results with your complaints and examination findings. If these don’t all point to the same underlying problem, treatment is less likely to be effective.
How Is Spinal Disc Herniation Treated?
Most lower back pain resolves itself in four to six weeks even if you don’t seek treatment. Oddly enough, the more damage to a disc, the faster spontaneous healing seems to occur.This could be because the body absorbs the nucleus material that’s leaked from the disc, relieving nerve pressure/irritation.
Treatment for all types of disc herniation is generally conservative and includes:
Other options include alternative and complementary approaches, likeacupunctureorAyurvedic traditional medicine.
Surgery is generally recommended only when conservative treatments aren’t working, if you have significant muscle weakness from nerve damage, or when motor functions are compromised.
One herniation-related condition of the lower back,cauda equinasyndrome, is considered a medical emergency and requires immediate care. It can causeurinaryor bowel dysfunction, numbness around the anus, along with traditional herniation symptoms.
Does a Disc Herniation Require Surgery?There are many cases in which a disc herniation does not require surgery. One strategy is immune-mediated treatment. Because of anatomy, theimmune systemfrom birth never develops a tolerance to the nucleus pulposus cells. Inflammation occurs when they escape during herniation, and motor control training is meant to harness the power of the immune system’s response to promote spontaneous healing, though more research is needed into how it works.
Does a Disc Herniation Require Surgery?
There are many cases in which a disc herniation does not require surgery. One strategy is immune-mediated treatment. Because of anatomy, theimmune systemfrom birth never develops a tolerance to the nucleus pulposus cells. Inflammation occurs when they escape during herniation, and motor control training is meant to harness the power of the immune system’s response to promote spontaneous healing, though more research is needed into how it works.
Herniated Disc Surgery: Overview
Summary
Mild back or neck pain may not be a reason to see a healthcare provider unless it persists for several weeks, but more severe symptoms including radiculopathy warrant care. Back pain and injuries can be complex, challenging, and frustrating. If your healthcare provider suspects disc herniation, no matter the type, your diagnosis should combine MRI results along with your specific symptoms and how they progress over time.
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