Disc extrusion is when the jelly-like cushion of the spine breaks away from the vertebrae, causing pain or numbness. Diagnosis includes X-rays, CT scans, and MRIs. Conservative treatment includes rest, therapy, and medication. Invasive procedures may be necessary if pain persists.
Disc extrusion is a condition in the spine where the core of the disc breaks away from the vertebrae. This release of the jelly-like cushion of the spine can occur due to some type of injury or normal wear and tear on the area. It can occur with or without pain.
Disc extrusion occurs when the disc breaks the ring or fibrous shell that surrounds it. Disc material can press against a nerve and mask pain symptoms. Pain from a disc protrusion can range from no pain to numbness and tingling in the arm or back of the leg, also known as paresthesia, to generalized weakness, depending on the area of the break. Radiculopathy or radiating pain is not uncommon when disc material presses on a specific nerve. In severe cases, there may be a lack of bladder control or an inability to flex the ankle.
Proper diagnosis of an extruded disc can include X-rays, CT scans, and MRIs. For more serious and complicated pain problems, EMG or electromyography, also known as nerve conduction tests, may be needed to assess the exact location of the pain.
Conservative treatment of a disc extrusion includes rest, heat/cold therapy, NSAIDs, or nonsteroidal anti-inflammatory drugs. Physical therapy can help reduce pain through modalities such as electrical stimulation machines and ultrasound. It may also attempt to pull the disc materials back into the fibrous sheath through specialized exercises and tensile treatments. Physical therapy can also maximize function by strengthening surrounding muscles and re-teaching proper body mechanics to avoid further injury. Massage therapy can help reduce pain and loosen 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 conservative treatments since they are non-invasive. Chiropractors can realign the spine to coax the extruded materials back into their original space. Acupuncture uses specialized needle placement to achieve relief.
If pain persists and interferes with daily activities, an invasive procedure may be necessary. However, it is important to ascertain the exact location of the pain. If surgery is performed on a disc extrusion but it is not the location itself that is causing pain, the surgery will not be successful. An epidural or nerve injection of steroids into the area may provide temporary relief. Surgical options range from minimally invasive endoscopic procedures to more complex ones such as open decompressions, placement of interspinous spacers, discectomies, fusions and total disc replacements.
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