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Disc herniation is a tear or break in the material between the vertebrae of the spine. Disc sequestration is the most severe degree of disc herniation, in which the nuclear material of the disc leaks out and completely separates with the disc. Symptoms vary depending on the severity of the herniation and the location of the offending disc. Surgery is necessary if the nuclear material is released completely.
Disc sequestration is the most severe degree of disc herniation, in which the nuclear material of the disc leaks out and completely separates with the disc. A herniated disc, also called a prolapsed disc, slipped disc, or ruptured disc, is a tear or break in the material between the vertebrae of the spine. These discs serve to cushion the movements of the bones. They are composed of a tough fibrous layer called ring fibrosis that surrounds a gel-like substance called the nucleus pulposus. When a disc herniates, the annulus fibrosis undergoes a tear which allows the nucleus pulposus to be squeezed.
Symptoms of a ruptured disc vary depending on the severity of the herniation and the location of the offending disc. Disc herniations are classified based on the posterior longitudinal ligament (PLL) and degree of rupture. The posterior longitudinal ligament runs vertically along the spine and carries each disc to its posterior or posterior side. The PLL separates the posterior side of the disc from the epidural space, which surrounds several spinal nerve roots. The three classifications of a herniated disc are protrusion, extrusion, and sequestration.
Disc protrusion results in swelling of the disc and tearing of the annulus fibrosus, but no damage to the PLL, so that the nuclear material is contained. The protrusion can present without pain or severe pain, depending on whether or not the swelling affects the nerves. Disc extrusion results in complete rupture of annulus fibrosis, allowing nuclear material to seep into the epidural space. This presents a similar range of symptoms to disc protrusion, with the severity depending on whether the nerves are compressed.
Disc sequestration means that the nucleus pulposus has completely exited the disc and separated with the disc due to a rupture of the PLL. The nuclear material can then travel into the epidural space and is considered a free fragment. This condition is often severely painful, with pain in the back and, in some cases, the leg. In severe cases, the patient may develop cauda equina syndrome, which can cause loss of bowel control and numbness in the legs. This is considered a medical emergency that needs immediate surgery and can lead to permanent neurological damage if left untreated.
In most cases, disk sequestration occurs in older patients because the integrity of the disk degrades over time, making it more susceptible to herniation. Gradual strain on the disc, sharp strain, or a combination of both can cause a rupture. Although most disc herniations do not require surgical treatment, decompressive surgery is usually necessary if the nuclear material is released completely. Candidates for surgery are those with cauda equina syndrome, muscle wasting, and those for whom nonsurgical treatments have failed.
The surgery is called discectomy and can be performed differently depending on the individual case. The surgeon will remove some or all of the disc and sometimes insert mesh to reinforce what remains or insert a prosthetic disc. The patient may have the option of a traditional open discectomy, microdiscectomy, or endoscopic discectomy. A doctor will discuss with the patient which course of action is best for any particular case.
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