Disc protrusion

What is a disc protrusion? This is a disorder of the spinal column in which the spinal disc protrudes into the spinal canal without breaking the fibrous ring. Many specialists characterize this condition as pre-herniated.

Protrusion is not an independent pathology. It is a consequence of some other pathological process in the spine, mainly occurring in the lumbar or cervical area.

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Causes of disc protrusion

What can be a factor in the development of protrusion? There are several options:

• age-related development of osteochondrosis is the main reason;
• traumatic injuries of the spinal column;
• various forms of curvature of the spinal column;
• hereditary factor;
• presence of excess weight;
• mechanical and physical overload of the spine.

Protrusion occurs due to a change in the structure of the fibrous ring of a certain disk, a violation of the structure of fibrous tissue. The integrity of the outer shell of the ring is not violated (if the outer shell of the ring is damaged, then we can already talk about an intervertebral hernia ). The visible protrusion can reach 1-5 mm, and even more, and the size of the protrusion up to 3 mm is considered harmless and may not show any symptoms.

Why do we feel pain when there is a protrusion? The resulting protrusion of the disc protrudes into the spinal canal, squeezing, irritating and pinching the nerve fibers and vessels passing there. In addition, the function of the vertebra itself may be impaired.

Symptoms of disc protrusion

Often, protrusion occurs without obvious signs and symptoms: protrusion of the ring up to 3 mm may not cause sufficient irritation of the nerve endings. Also, the presence of signs of pathology depends on the localization of the disorder and the degree of protrusion of the disc into the spinal canal.

Localization of protrusion in the area of the cervical vertebrae is considered the most dangerous for the patient’s health.

Pain may manifest itself in the neck, back of the head, intercostal area, and radiate to the upper and lower extremities (depending on which nerve is being compressed). There may be loss of sensitivity in certain areas of the extremities (numbness), weakness in the muscles, nagging pain along the muscles, and sciatic nerve disorders. Stiffness of the motor range of the extremities and neck, and burning pain in the affected area are also often observed.

The extent to which certain symptoms will be expressed may depend on the primary disease that caused the development of the protrusion. The degree of compression of the nerve endings is also important.

Manifestations of the disease are often individual in nature; sometimes pain may only occur with sudden movements, bending, prolonged standing or sitting.

Types of disc protrusions

Let's consider some existing types of protrusions, which differ depending on the location and nature of the protrusions.

Dorsal disc protrusions

The most dangerous type of pathology. It is most often found in the lumbar spine. The difference between this protrusion and its other varieties is that with this disorder, the protrusion is directed towards the spinal cord canal. This means that under certain conditions, compression of the spinal cord is possible even with a small size of the bulge. This is fraught with the development of significant pain syndrome, especially after excessive motor activity or an uncomfortable and incorrect position of the back. During a relapse of the pathology, pain can be caused even by a deep breath or coughing. Symptoms of dorsal protrusion are still not global: the pathology can be treated if it is undertaken in a timely manner.

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Circular disc protrusion

This variant is the most common and is a uniform circular protrusion of the disc with accompanying degenerative and dystrophic processes in the spinal column. The protrusion can be within the range of 3-12 mm, and the difference in the protrusion of the disc can be no more than 1 mm. This pathology is characterized by a chronic course and, in the absence of appropriate therapy, usually leads to an increase in neurological symptoms and the onset of disability.

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Median disc protrusion

Synonyms - medial, central, dorsomedian, posterior median). It is a protrusion of the fibrous ring directed into the central part of the spinal canal. Medial disc protrusions are uncommon, their prevalence is no more than 6% of the total number of protrusions. Median disc protrusion is rarely diagnosed in the early stages, the disease can occur without any obvious signs and symptoms that would force the patient to see a doctor. Such pathologies are dangerous due to their relatively hidden symptoms, and in the absence of proper treatment, they can increase, provoking more serious complications, sequestration. Median protrusion puts pressure on the spinal cord, which can subsequently cause paresis, dysfunction of the abdominal organs.

Paramedian disc protrusion

This type of protrusion is observed when the protrusion is located both in the center of the midline and in its lateral part. The protrusion can be directed at the spinal foramen, the spinal canal. Paramedian protrusion can be right- or left-sided. This differentiation depends on which side of the spine the nerve fibers are compressed on. This is also determined by the symptoms of the disease: the patient notes pain, paresthesia, muscle weakness, deterioration of visual and auditory functions to a greater extent on the right or left side.

Foraminal disc protrusion

A rare form of protrusion, which is characterized by protrusion towards the outer or inner edge of the spinal canal. According to this principle, foraminal protrusion is divided into extraforaminal and intraforaminal. There is also a lesion along the entire length of the canal, as a complicated course of the listed forms of protrusion. This variant is called foraminal protrusion proper. The lumbosacral region of the spinal column is most susceptible to this form of the disease.

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Posterior disc protrusion

This name is usually applied to signs of a topical protrusion backwards in the direction from the abdomen to the back. Especially often, such localization leads to close contact of the fibrous ring with the spinal cord, which is fraught with pain, loss of sensitivity of some areas, impaired motor skills, and functionality of the abdominal organs.

Posterolateral (posterolateral) disc protrusion

A very common type of protrusion. The name suggests that the formation of the protrusion occurs posteriorly and laterally relative to the axis of the spine. This location of the pathology increases the possibility of influencing the nerve endings on both sides, as well as the remaining structural segments of the spinal cord. Like the lateral type, the posterolateral protrusion tends to be asymptomatic until mechanical impact on the nerve fibers is detected.

Degenerative disc protrusion

This name is applicable to all types of protrusions, since the very occurrence of pathology is directly related to the development of a degenerative process in the structure of the fibrous ring surrounding the disc. As a result of this process, the ring becomes thinner, becomes inelastic, microcracks form in it, to which the pulpous jelly-like nucleus shifts. A convex element is formed, which we call a protrusion. The degenerative process can go through several stages:

• damage (swelling of the nucleus pulposus);
• protrusion (protrusion of the nucleus into the spinal canal without rupture of the fibrous ring);
• hernia (violation of the integrity of the fibrous peridiscal ring).

Tissue degeneration can be a consequence of osteochondrosis, dysplasia, postural disorders, and traumatic spinal injuries.

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Polysegmental disc protrusion

A pathology in which degeneration and dystrophic changes are observed simultaneously in several segments of the spinal column. As a rule, it is a consequence of polysegmental osteochondrosis and may be accompanied by signs of vertebrobasilar insufficiency (headaches, dizziness). It is often determined in the cervical spine, less often in the cervicothoracic and mid-thoracic zone.

Diffuse protrusion of intervertebral discs

This type of pathology is characterized by uneven and repeated protrusion of the disc of any section of the spine. Diffuse protrusion indicates that the disc is damaged by 25-50% - this is a fairly strong protrusion. The prognosis for such damage depends on its size and direction of formation.

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Cervical disc protrusion

When pathology occurs in the cervical discs, a reaction of compression of the spinal structures is observed. This provokes the appearance of neck pain, weakness of the muscles of the shoulder girdle, upper limbs, numbness and pain along the arm.

The cervical spine has seven vertebrae: between them are located discs. Wear of these discs contributes to the appearance of protrusions.

C3-C4 disc protrusion

This term indicates that the damage occurred in the cervical spine, in the central part of the cervical part between the third and fourth cervical vertebrae. The pathology can only be confirmed by magnetic resonance imaging of the cervical spine. Most often, such pathology occurs as a result of traumatic impact on this area.

Disc protrusion C5-C6

One of the most common protrusions in the cervical region, localized between the fifth and sixth cervical vertebrae. May occur against the background of a hernia, cervical kyphosis, lesions of other intervertebral discs. Symptoms of this pathology are headaches, numbness in the fingers, pain along the upper limb, muscle weakness of the wrist and biceps, pain in the neck. Pinching of the C6 nerve ending can manifest itself in the form of a violation of the sensitivity of the thumb and index finger. The causes may be injuries or osteochondrosis of the cervical region.

Disc protrusion C7-C6

Disc protrusion in the area between the seventh and sixth vertebrae. Manifested by neck and headaches, stiffness of head movements, impaired sensitivity of the fingers. Pathology is amenable to conservative treatment. In the absence of necessary therapeutic measures, it can lead to the development of a hernia, vertebrogenic radiculopathy.

Protrusion of thoracic discs

Protrusions of the thoracic spine discs are rare. This is explained by the fact that the motor activity of the thoracic vertebrae is an order of magnitude lower than that of the lumbar or cervical localization, so the wear of the discs occurs less frequently. However, despite this, a certain mobility is still present, and protrusions can form in the discs during the dystrophic process.

The clinical picture of the disease directly depends on the location of the pathology and the degree of compression of the nearest nerve endings. The following symptoms are usually present:

• pain in the middle part of the spine;
• intercostal neuralgia;
• limited mobility of the back;
• weakening of the abdominal wall muscles;
• feeling of pressure in the epigastric region;
• cardialgia;
• respiratory disorders;
• a feeling of numbness in the front of the body.

The manifestations of the pathology are individual, therefore, to make an accurate diagnosis, it is necessary to undergo a number of additional examinations.

Lumbar disc protrusion

Perhaps the most vulnerable area of the spine is the lumbar region. The center of gravity of the body is located here, so it is this area that bears the bulk of the overall physical load. Symptoms of the disease include radiculitis, lumbar pain, weakness and numbness in the lower extremities. In severe cases, dysfunction of the urinary system is possible.

• L2-L3 disc protrusion is a rare type of protrusion, occurring in 1% of cases. It is accompanied by shooting pains in the lower back, loss of sensitivity in the feet or toes. Protrusions of significant size, which provoke urination disorders, are subject to surgical therapy.
• Protrusion of the L5 disc. Damage to the fifth lumbar vertebra disc may be observed in the following combinations:
• L5-S1 disc protrusion is a defect of the fibrous ring between the first sacral and fifth lumbar vertebra. A very common area of damage, it can be observed in half of the cases of lumbar protrusions. Often combined with anterospondylolisthesis, retrospondylolisthesis, spondyloarthrosis, uncoarthrosis, intervertebral hernia. It can be provoked mainly by osteochondrosis changes. As a consequence of such damage, the development of pinching of the lumbar and sacral nerve endings, or the nerve bundle in the spinal canal is possible.
• L4-L5 disc protrusion is a defect between the 4th and 5th lumbar vertebrae. It can occur in 40% of lumbar lesions. In most cases, it is accompanied by a hernia or protrusion of L5-S1. It is provoked by traumatic injuries or constant significant physical exertion. Usually, the pain occurs suddenly, against the background of a “lumbago” - a kind of crunching sound that follows lifting something heavy or bending over.
• L3-L4 disc protrusion is a defect between the 3rd and 4th lumbar vertebrae. It is not observed very often, only in 5% of situations. It rarely manifests itself separately, more often together with damage to adjacent lumbar and sacral discs or vertebrae.

Consequences of disc protrusion

To explain what consequences may occur with disc protrusion, it is necessary to trace their appearance step by step:

• the occurrence of protrusion begins with a change in the structure of the disc. Its fibers weaken, degenerative destruction of tissue occurs, the ring around the disc becomes covered with microcracks. During this period, the patient may feel some pain and muscle discomfort;
• at the next stage, a protrusion of the ring occurs. The pain becomes more intense, paresthesia may be observed;
• the final stage is the consequence. In the absence of proper treatment, the microcracks of the ring form into a rupture - in fact, this is already the stage of intervertebral hernia. The pain becomes acute, movements in the spine are impaired, and loss of sensitivity of parts of the limbs occurs.

In addition to hernia, the risk of the disease may be hidden in the possible compression of nerve fibers. This leads to disruption of tissue innervation and, as a result, to partial or complete paralysis.

Agree, the consequences of this disease are such that maximum efforts should be made to treat protrusion. See a doctor in a timely manner, without waiting for dangerous symptoms to appear.

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Diagnosis of disc protrusion

Qualified diagnostics of this pathology is based, first of all, on the presence of characteristic clinical symptoms of protrusion. Consultation with a neurologist and vertebrologist may be required.

Among the instrumental methods of research, it is necessary to highlight the main diagnostic method - magnetic resonance imaging (MRI) of the damaged area of the spinal column. This method provides almost exhaustive information about the presence, size, degree of development of protrusion and hernias, the condition of the spine as a whole, the formation of inflammatory foci.

Research using a computed tomography scanner is sometimes used, however, this is not a very informative method and has a large error in diagnosis.

X-ray examination can also be considered a possible, but uninformative method.

A number of additional studies may be prescribed to clarify the presence of an inflammatory process in the tissues: this includes the use of positive myelography, pneumomyelography, venovertebrography, vertebral arteriography, discography, epidurography, pneumoepidurography. The doctor makes a decision on such studies individually.

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Treatment of disc protrusion

Treatment of the pathology is complex, conservative, using traction in inpatient and outpatient settings.

Treatment of disc protrusion in the lumbar region and other parts of the spine should be aimed at preventing the increase in manifestations of osteochondrosis of the spinal column: a correct work schedule, exclusion of significant and prolonged loads, as well as heavy physical labor.

The basis of therapeutic measures aimed at treating L5-S1 disc protrusion and other types of lumbosacral lesions is the elimination of pain and nerve fiber compression syndrome, restoration of trophism and muscle innervation.

Drug treatment of intervertebral disc protrusion may include: - symptomatic therapy aimed at reducing swelling of the perivertebral area and relieving pain. This may include the use of non-steroidal anti-inflammatory drugs (diclofenac, nimesil, ibuprofen, orthofen, movalis, etc.), antispasmodics and muscle relaxants (mydocalm, sirdalud), analgesics (analgin, butadion). The drugs should affect the development of degenerative processes in the tissues and relieve the inflammatory reaction. Injections for disc protrusion are prescribed during the first few days of treatment: the most common is 2.5% sodium diclofenac solution for intramuscular injections. Subsequently, they switch to oral medications. If the pain does not go away within three days of treatment, you should immediately consult a doctor.

It is also important to use external preparations in the form of ointments and creams (viprosal, diclofenac gel, diclac gel, fastum gel, espol). Such products are used starting on the 3rd-4th day of treatment against the background of general drug therapy.

• rehabilitation methods that accelerate the regeneration process and strengthen the muscular corset. This may include the use of exercise therapy for disc protrusion (including underwater - in a pool), swimming procedures, a traction method in a therapeutic traction chair or surface, a traction method with immersion in warm water in an inclined or horizontal position, as well as vertical traction while floating in special equipment in a pool. Massage for disc protrusion can be combined with other physiotherapeutic procedures (electrophoresis, light therapy, acupuncture, point massage). The combination of procedures with different effects helps to relax spasmodic muscles, relieve pain, and strengthen the back muscles.

Sometimes manual correction of "bulging" is practiced. However, such manipulations should only be performed by a qualified specialist with certain skills and techniques.

There are situations when conservative treatment does not bring the expected result. In such cases, it is possible to use minimally invasive surgical interventions by puncture. Among such procedures, the following can be distinguished:

• bone block method. Involves the introduction of a drug directly into the spine at the site of pathology. The patient feels the effect of the method almost immediately: the pain subsides, the swelling goes away, the muscle spasm weakens;
• laser vaporization of the disc. A fairly effective procedure, used, however, only in the early stages of the pathology, when the nucleus still has a glandular consistency. The procedure involves the action of a laser on the protruding nucleus pulposus (the so-called "cauterization").
• hydroplasty method. The most gentle procedure. Under pressure, a special liquid is injected into the center of the damaged disc. The liquid washes away the damaged areas of the disc, hydrotizing the undamaged areas. The procedure is monitored throughout its entire duration (about 20 minutes) using X-rays. The method is recognized as one of the most effective.
• cold plasma nucleoplasty method. It involves the introduction of cold plasma into the damaged disc, which evaporates parts of the nucleus, reducing disc pressure. Due to this, the impact on the nerve endings is minimized and the pain subsides.

Gymnastics for disc protrusion

It is worth noting that exercises for disc protrusion are prescribed and controlled by a doctor, since incorrectly performed movements can not only fail to cure, but also aggravate the problem. The set of exercises must be approved and verified by a doctor.

• First exercise. Lie on your back, arms at will, legs bent at the knees. Raise your pelvis, leaning on your feet and shoulder girdle. Perform with repetitions up to 10 times.
• Second exercise. Squat down, resting your knees and palms on the floor. Raise your right arm and left leg at the same time, and vice versa. Repeat several times.
• Exercise 3. Lie on your back, legs straight. Move your torso upward (as if doing abdominal exercises), holding the top position for a few seconds. Repeat as often as possible.
• Exercise 4. Lie on your back, arms and legs straight. Raise your straight legs at an angle of 30-45 degrees and do cross swings ("scissors"). Repeat up to 10 times.
• Exercise five. Sit on the floor, legs straight. Try to reach your toes with your palms.
• Exercise six. Lie on your stomach, legs and arms straight. Raise your upper body without lifting your legs and stomach off the floor. Hold the top position for a few seconds, then lower yourself. Repeat up to 10 times.

Before exercise, it is advisable to warm up the muscles with regular physical exercises or light jogging. Gymnastics will be more effective if combined with swimming.

Treatment of disc protrusion with folk remedies

As an adjuvant to drug therapy, the following herbal mixtures are used for their analgesic, anti-inflammatory, tonic and bactericidal effects:

• black elderberry flowers, birch leaves, willow bark in a ratio of 1:4:5. Take the infusion ½ cup up to 4 times a day before meals;
• black elderberry flowers, stinging nettle leaves, parsley root, willow bark in equal proportions. Take the infusion ½ cup up to 4 times a day before meals;
• birch leaves, stinging nettle leaves, wild pansy grass in equal doses. The infusion is taken ½ cup up to 6 times a day before meals.

Vitamin tea made from blackcurrant leaves, lingonberries and rose hips, mixed in equal parts, enhances the anti-inflammatory effect. Drink two cups of tea a day before meals.

A bath with chamomile decoction gives a good effect: this procedure improves blood circulation in the pinched areas and relieves signs of inflammation.

Folk remedies are certainly good. However, they should not be used as an independent treatment method. Only in combination with traditional medicine can you achieve the desired result and cure spinal injury.

Diet for disc protrusion

Any pathologies of the spine associated with the development of degenerative processes require certain changes in nutrition. Food for protrusions should be rich in minerals, vitamins, and should not contain substances that destroy the bone system.

In the production of cartilage and connective tissues, the presence of chondroprotectors and collagen fibers plays a special role. Such substances are contained in bone broth and gelatin, so eating jelly desserts, aspic, jellied meat and fish will be very useful.

You should drink enough fluids to maintain electrolyte balance and remove toxic substances from the body that have formed as a result of the inflammatory process.

It is very important not to overeat: with a protrusion, there is absolutely no need for additional stress on the spine, which is created by an overfull stomach and excess weight.

It is necessary to limit the daily amount of salt. The so-called "salt deposits" are an invariable companion of osteochondrosis, the root cause of protrusion. In order to reduce the load on the skeletal system and reduce the amount of salts in the body, it is not enough to just drink water. It is also necessary to give up salty, smoked, spicy foods. It is also advisable to reduce the amount of sugar - we have already talked about excess weight.

Among the essential products that should be on the table of a patient with a disc protrusion, one can single out a sufficient amount of dairy products, legumes, vegetables, greens and nuts. These are products containing calcium, magnesium, manganese, and vitamins necessary for the bone system.

Try to get rid of the habit of drinking coffee in the morning - coffee removes calcium from the body, and can also interfere with its absorption. As a last resort, if you really can't give it up, drink coffee with milk or cream: this will help maintain the calcium balance. But no more than a cup a day!

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Prevention of intervertebral disc protrusion

What can serve as a prophylaxis for protrusion? First of all, it is necessary to take care of the back and spine: avoid physical overload, injuries, colds. It would not be superfluous to periodically visit a doctor - a chiropractor, vertebrologist, osteopath.

There are many types of massage effects - reflex massage, relaxing, therapeutic, shiatsu. All of them bring not only pleasure, but also activate metabolic processes in the skin and muscle tissue, improve regeneration processes.

Yoga classes have a good preventive effect. Practice shows that yoga perfectly heals and strengthens the back muscles, and also improves the mobility of the spine.

It is important to watch your posture: when standing, walking, and especially when sitting for a long time. Do not slouch, do not bend your back. If you have a monotonous back position for a long time, try to take breaks, get up, walk, do simple physical exercises.

Do physical exercises in the morning, swim in the pool during the day, or engage in your favorite sports.

Watch your weight: obese people are more susceptible to diseases of the spine and skeletal system.

Probably, each of us at least once felt pain in the neck or lower back, often without attaching much importance to it. Pain is a signal. A signal that not everything is well in the body, it is a call to action.

If you feel pain, do not be lazy, contact a good specialist if you do not want to ever end up on the operating table with an advanced stage of the disease. Disc protrusion can be treated conservatively if it is started on time.