Extruded DiscAn extruded disc is also sometimes called a transligamentous disc, or more commonly, a ruptured disc. Disc extrusions represent a minority of herniations, compared to the more common bulging disc profile. Symptoms and treatment options for ruptured discs can vary somewhat from contained disc herniations.
Ruptured discs typically begin as simple bulges and escalate due to degeneration or traumatic
injury.
However, it is possible for a normal and healthy disc to undergo a sudden extrusion from extreme and focused injury, such as a
car accident.
A disc bulge describes a condition in which the outer
annulus fibrosus
(disc wall) remains intact and free from annular tears. In an extrusion, the outer annulus rips open, allowing some of the softer
nucleus pulposus
to spill from the disc structure. Sometimes the leaking nucleus material remains attached to the disc, while other times, the fragment breaks completely free and migrates
(sequestered disc).
Basically, a rupture describes a general condition in which the inner core manages to break through the outer wall, compromising the structural integrity of the entire disc.
Besides the usual possibility of nerve compression enacted by any bulging or ruptured disc (
spinal stenosis,
foraminal stenosis
or
pinched nerve
conditions), extrusions also create the chance for
chemical radiculitis.
This controversial diagnosis seems to affect some patients with disc extrusions, but not others. The inner disc nucleus is composed of proteins which might have an irritating effect on some surrounding neurological tissue. This can cause pain which might be quite severe in some patients. Luckily, specific forms of effective
epidural injection
therapy have demonstrated good curative results for confirmed cases of chemical nerve pain. Just remember that this diagnosis is also a typical
scapegoat
for unexplained back pain and in these cases, the rupture condition itself does not seem to create any ill effects in the affected patient…
Extruded Disc AdviceRuptured discs seem to be worse than merely bulging discs upon first observation; however, this is not always the case. While ruptures can cause severe pain in some patients, they might also help to relieve pain in others. A minority of disc pain sufferers actually endure a pinched nerve condition from a bulging, but intact disc. Sometimes, if the disc ruptures, it actually relieves pressure off the nerve tissue, ending the pain. Additionally, the ruptured disc material can calcify, sometimes supporting the compromised intervertebral level and providing some measure of lasting relief for the patient. It is crucial to remember that disc conditions rarely cause the type of extreme or lasting pain they are often blamed for. In many cases, the disc is completely innocent and in other cases, the painful disc only enacts symptoms for a short time. Lasting pain beyond the normal healing phase for a disc bulge is typically the result of an ischemic process often linked to the diagnostic nocebo effect of the original injury…Extruded Disc to Herniated Disc 6/29/09 Revised 7/15/11 |
Sensei Adam Rostocki
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