Disc extrusion is a condition in the spinal column where the nucleus of the disc ruptures out of the vertebrae. This spillage of the gel-like shock absorber of the spine can occur from some type of injury or from normal wear and tear of the area. It can occur with or without pain.
Disc extrusion occurs when the disc breaks through the annulus, or the fibrous enclosure surrounding it. The disc material can press against a nerve and disguise the pain symptoms. Pain from a disc protrusion can range from no pain at all to numbness and tingling down the arm or the back of the leg, also known as paresthesia, to generalized weakness, depending on the area of disruption. Radiculopathy or radiating pain is not uncommon when the disc material is pressing on a specific nerve. In serious cases, lack of bladder control or the inability to flex ankle up may be present.
Proper diagnosis of an extruded disc may include x-rays, CT scans and MRIs. For more serious, complicated pain issues, EMGs or electromyography, also known as nerve conduction tests, may be necessary to assess the exact location of pain.
Conservative treatment of a disc extrusion includes rest, heat/cold therapy, NSAID’s or non steroidal anti-inflammatory medications. Physical therapy can assist in decreasing pain through modalities such as electrical stimulation machines and ultrasound. It can also attempt to coax disc materials back inside the fibrous enclosure through specialized exercises and traction treatments. Physical therapy can also maximize function by strengthening surrounding muscles and re-teaching proper body mechanics to avoid further injury. Massage therapy can assist with decreasing pain and loosening tight muscles surrounding the injured area. Both types of therapists may be able to demonstrate coping techniques to avoid further pain and injury.
Chiropractic and acupuncture are also considered to be conservative treatments since they are non-invasive. Chiropractors can realign the spine to coax extruded materials back into their original space. Acupuncture utilizes specialized needle placement to gain relief.
If pain persists and is interfering with daily activities, an invasive procedure may be necessary. However, it is important to ascertain the exact location of pain. If surgery is performed on a disc extrusion but it is not the same location that is causing pain, the surgical intervention will be unsuccessful. An epidural or nerve block injection of steroids to the area may provide temporary relief. Surgical options range from minimally invasive endoscopic procedures to more complex ones such as open decompressions, the placement of interspinous spacers, discectomies, fusions and total disc replacements.