Disc bulges, herniations and extrusions all sound scary, but what do they actually mean? And what is the difference between them all?
Hopefully by the end of reading this you’ll have a better understanding and can brag to all your family and friends
Before we go into the difference between them all we need to have a quick brush over the anatomy of the spine. In the diagram above this shows a cross section of the 5 lumbar vertebrae (centre image), in between the vertebrae (L1-5) you can see the intervertebral discs that we’ll be referring too, they are flat and cartilaginous disc that acts as a shock absorber in the spine. These discs are ‘viscous’ meaning they are solid but have liquid like tendencies, meaning they are malleable and adapt to load and stress. They are robust and tough structures but they do wear down as life passes by.
Odds are you or someone close to you has been told they have a bulging disc in their spine. That is because this is a super common finding that we see in the clinic all the time. In fact many of the general population will have bulging discs and have absolutely no idea, and often will be living their life without pain or restriction. In a recent study it was found that 30% of people aged 20 years old without back pain in fact have bulged discs in their spine. This number steadily increases with 96% of 80 years olds having disc bulges. (Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Brinjikji et al. 2015).
This tells us that disc bulges are a normal sign of ageing and no not always cause pain.
There are many analogies that people have used to describe disc bulges in the past, Essentially the disc can inflame and expand outside it’s ‘normal’ resting place. If the bulge does not affect any nerve or structure it is unlikely it will cause pain or affect your daily living. If the bulge does happen to put some pressure on a nerve (or inflammation affects the nerve) then this is where we might get some pain.
But the good news is, that disc bulges can heal! The outer structures of the disc are still intact, with adequate recovery (increased mobility and strength) the disc gets stronger and will tolerate more stress. Time frames will vary based on location and level of bulge but expect 4-16 weeks. Check out our blog on disk bulge
A disc herniation is where there is a weakness in the outer structure of your disc (annulus fibrosus) creating a space for the nucleus pulposus (refer back to first image) to push through the outer wall of the disc. Just like a disc this can also cause no symptoms, but is more likely to affect surrounding structures of the spine. A disc herniation is a cause of more commonly known problems such as sciatica, this is because the disc is pushing on the spinal cord.
Most of the population will be living with some form of disc herniation, this is most commonly due to age and degeneration as the viscous fluid and outer fibrous tissue becomes weaker over time, leaving weak spots.
Second most common cause is trauma, such as car accidents, bad lifting accidents or a heavy fall
Disc herniations can very from minimal to quite large. Some Symptoms of herniation can be muscular spasm, pins and needles (or nerve referral to legs/arms), back pain, pain on coughing and sneezing. And in more serious cases loss of bowel or bladder control (emergency) but this is not common.
How do we diagnose? Based on your case history, movement and orthopedic examination we can get a reasonable suspicion of a disc herniation, but an MRI is the only completely accurate way to see where and how much the disc is herniating.
Treatment – for herniations no two backs are the same. Most people will recover with physical therapy and pain management strategies. Like disc bulges they have a wide variation in the time it takes to get better. In fact a recent study suggests that a ⅓ of herniations will spontaneously reabsorb.
Some lifestyle strategies that you can influence yourself are to – decrease your weight, remove smoking and alcohol, do low impact activities and get strong.
In more extreme cases of a disc herniation, medical intervention may be required including pain or anti-inflammatory medications, cortico-steroid injections and the absolute last option will be surgical intervention.
A disc extrusion is just one form of a disc herniation. In fact there are three types of herniation.
Protrusion – Where the disc wall is damaged and allows a bulge, but the fluid inside the disc stays intact. Note that it isn’t too dissimilar to a disc bulge
Extrusion – The outer wall of the disc breaks and the fluid of the disc breaks through the wall into the spinal canal, but still remains in one total piece.
Sequestration – The most serious is where the fluid-like structure breaks through the wall and completely separates from the rest of the disc leaving it floating/resting in the spinal canal on its own, this has the potential to cause serious conditions such as cauda equina syndrome.
However even sequestrations can reabsorb and heal themselves! Our bodies are amazing things with the ability to adapt and overcome serious injuries in most cases!
Next time you get some imaging done on your spine, don’t fret with the words bulging, herniating and extruding, because they can heal with conservative management, odds are you had them before your back even started to hurt. Get it assessed by your health professional (of course your favourite OSteopaths at Sports & Spinal Albury Wodonga)who will rule out serious red flags and begin your rehabilitation journey!
If you take anything out of this blog, don’t be afraid of what your scans tell you, education is power, conservative management and natural healing is often all that’s required, get moving and get strong!