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Herniation of the pulp nucleus: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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A herniated nucleus pulposus (bulging, rupture, or prolapse of an intervertebral disc) is a prolapse of the central portion of the intervertebral disc through the annulus fibrosus.
Symptoms of nucleus pulposus herniation occur when the disc presses on the adjacent nerve root, causing segmental radiculopathy with paresthesia and weakness in the distribution of the affected nerve. Diagnosis of nucleus pulposus herniation is made using CT, MRI, and CT myelography. In mild cases , treatment of nucleus pulposus herniation includes NSAIDs and, if necessary, other analgesics. In rare cases, bed rest is indicated. In case of increasing neurological deficit, intractable pain, or sphincter dysfunction, urgent surgery (eg, discectomy or laminectomy) is indicated.
Causes of herniated nucleus pulposus
Between the vertebrae are cartilaginous discs consisting of an outer annulus fibrosus and an inner nucleus pulposus. When degenerative changes (with or without trauma) cause a protrusion or rupture of the annulus fibrosus in the lumbosacral and cervical regions, the nucleus is displaced posteriorly and/or laterally into the epidural space. When a disc herniation presses on a nerve root, radiculopathy results. Posterior protrusion may compress the spinal cord or cauda equina, especially in congenital spinal stenosis. In the lumbar region, greater than 80% of the disc protrusion affects the L5 or S1 nerve roots, and in the cervical region, it usually affects C5 and C7. Disc herniation is common and often asymptomatic.
Symptoms of herniated nucleus pulposus
Symptoms of a herniated nucleus pulposus, as with other lesions of the nerve roots, with a herniated disc, pain usually occurs suddenly, and spinal cord compression may also develop. With a herniated disc in the lumbosacral region, raising a straight leg (the roots are stretched) causes pain in the back or leg (if the disc herniation is in the center, the pain is bilateral). With a herniated disc in the cervical region, pain occurs when bending or tilting the neck. Compression of the cervical spinal cord can cause spastic paresis of the lower extremities. Compression of the equine tail often leads to urinary retention or incontinence due to dysfunction of the sphincters.
Diagnosis of herniated nucleus pulposus
A CT, MRI, or CT myelogram of the affected area is performed. An EMG may reveal the affected root. Asymptomatic disc herniations are common, so the physician must carefully compare the symptoms with the MRI data before prescribing invasive procedures.
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Treatment of herniated nucleus pulposus
If the neurological deficit is not severe and does not progress, conservative treatment of the nucleus pulposus herniation is indicated, since 95% of cases of intervertebral disc herniation recover without surgery in about 3 months. Heavy physical work should be limited, but walking and light loads (eg, lifting less than 2-5 kg) should be allowed if tolerated. Prolonged bed rest (including traction) is contraindicated. NSAIDs and other analgesics are used as needed to relieve pain.
If lumbar radiculopathy results in persistent or progressive neurologic deficits (weakness, decreased sensation) or severe, intractable pain in the distribution of the affected root, invasive procedures should be considered. Typically, this involves microscopic discectomy and laminectomy with removal of the herniation. Percutaneous access for removal of the disc herniation is still under evaluation. Chymopapain injections for herniation are not recommended. If severe compression of the spinal cord or cauda equina occurs (e.g., causing urinary retention or incontinence), immediate surgical intervention is indicated.
Immediate surgical decompression is indicated for cervical radiculopathy complicated by symptoms of spinal cord damage. In other cases, the question of it is raised only when non-surgical treatment is ineffective.