Disc Extrusion

Dr. Jonathan Hall

Dr. Hall is a Board Certified Neurosurgeon that specializes in treating patients that suffer from neck pain or back pain. He is able to perform minimally invasive spine surgery and the most complex procedures.

What is a Disc Extrusion?

More than a quarter of the population in the United States suffers from back pain due to degenerative spine conditions. A disc extrusion, more commonly known as a herniated or ruptured disc, is a degenerative spine condition which may lead to compression of the nerves, significant neck and back pain, and can even affect one’s ability to walk. The most common area of the spine to deal with an extruded disc is the lumbar spine, or lower back, which makes sense when you consider the fact that roughly 80 percent of adults experience lower back pain during their lifetime.

A disc extrusion occurs at the outer wall of an intervertebral disc when it tears causing the nucleus pulposus inside the disc to protrude into the spinal canal. This material is gel-like and slides through the tears. This can potentially compress spinal nerves sending either numbness or a searing pain into the body. Unfortunately, like a lot of degenerative spine conditions, a disc extrusion can actually be caused by the natural aging process — it can happen to anyone!

In some cases, it can also be caused by diseases like osteoarthritis or obesity. Whatever the cause, disc extrusions are not to be taken lightly. In fact, of all patients suffering from chronic back pain, it is estimated that two percent of them will suffer from a herniated disc, too.

Disc Extrusion Symptoms

In almost every case, an extruded disc will cause pain. This pain is considered “referred pain,” or pain that is felt in an area outside of the site of the disc extrusion. Some symptoms of disc extrusion include:

Tingling or numbness in the limbs
A burning or “pins-and-needles” feeling
Pain in the back, buttocks, groin, or thighs
Weakness in the lower extremities
Stiffness or soreness
Pain in the area of nerve compression
Pain in the neck or back
Muscle weakness
Irritation and inflammation
Incontinence of the bowel or bladder

Keep in mind that every patient experiences symptoms differently. From varying degrees of pain to the frequency of symptoms to the overall level of discomfort and the longevity for which an individual has been dealing with symptoms, there’s simply no surefire way to pin down the exact reason without consulting an orthopedic surgeon.These factors all influence the symptoms and the patient’s current level or threshold of pain.

What Causes Disc Extrusions (How Do They Develop)?

As previously mentioned, like a lot of degenerative spine conditions, life is commonly the mastermind behind the pain.

A disc extrusion develops when the rubbery discs that separate and cushion the vertebrae in the spine weaken and become brittle. These discs are tough and consist of a fibrous outer shell, called the annulus fibrosus, as well as a “gel-like” inner nucleus material. Over time, these discs are put under distress from normal wear and tear, similar to a vehicle, and like a vehicle, you need to check yourself into the body shop (e.g., outpatient clinic) every now and then for a quick tune-up (minimally invasive surgery). Eventually, tears can form in the walls of a disc due to pressure against the outer wall as a result of trauma, injury, or age. As the nucleic jelly-like center leaks out of the disc and into the spinal column, it results in a disc extrusion.

Some lifestyle factors may also be contributors to the cause of a disc extrusion. For example, contact sports such as football, or high impact sports like basketball where the players jump and stretch frequently causing repetitive high-impact shock absorption and compression. Other factors that may impact the spine include working a rigorous, labor-intensive job, participating in weightlifting, or being involved in a traumatic accident.

Luckily, there are several actions that can be avoided to help prevent an individual from suffering a disc extrusion, including:

Continuous standing
Sitting for several hours out of the day
Overexerting during exercise
Heavy lifting
Repetitive motions

While some of these are required by a job, or a particular lifestyle, it is important to be mindful of your body while performing them. By performing lower impact exercises, stretching, or working on improving your posture, you can reduce the chances of a disc extrusion ever occurring.

Spinal Regions Where Disc Extrusions Occur

Now for the good news! Proper management of an extruded disc can help restore the health of the disc and eliminate symptoms. Treatments vary from patient to patient, but some may find relief by engaging in simple lifestyle changes, such as:

Embracing a healthy diet
Taking part in low-impact exercises
Administering warm and cold compresses
Taking non-prescription anti-inflammatory medications

What Are Your Treatment Options with a Disc Extrusion?

In many scenarios, working with an orthopedic surgeon is the first step to fighting back against your symptoms. Starting with a proper diagnosis, which is usually attained through a magnetic resonance imaging (MRI) machine. An experienced spine surgeon will collaborate with a team of professionals, such as physical therapists and nutritionists, to devise and execute a whole-patient treatment plan that supports overall wellbeing and synergistic outcomes.

For many patients, a combination of surgery, mild medications, and physical therapy yields the best results, but your particular treatment will be determined during a conversation with your medical provider. During this conversation, they will explain the benefits or drawbacks of non-surgical and surgical treatments.

Non-Surgical Treatment

Aside from the treatments ascribed above, sometimes more aggressive conservative treatments are necessary. This is more typical when the pain is severe and greatly affects your quality of life or when the disc extrusion hasn’t responded to the other attempted treatment methods. For example, some patients may require an epidural steroid or anesthetic injections. These shots can help to reduce symptoms of nerve root compression often associated with pain and inflammation. These procedures are considered safe with only a few potential side effects. Steroidal injections have been in use for decades or more as a formidable pain management option.

Surgery for Disc Extrusions

Although surgery isn’t required for all patients who suffer from disc extrusion, it is one of the most effective treatment options for those seeking long-term relief for their symptoms. When conservative treatments have failed you, consider speaking to your medical provider about spinal surgery. If you are a good candidate for surgery, they will likely recommend a discectomy — a procedure that is used to help hundreds of thousands of patients every year.

A discectomy is performed by trimming away tissue and any other herniated disc material that has caused nerve compression. This surgery is minimally invasive and is boasts highly positive patient outcomes. If you are suffering from pain or inflammation in your lumbar spine, a discectomy may be the only way to find relief once conservative treatments have been ruled out.

It is important to note that patients who choose to undergo this surgery often report marked improvements to their pain symptoms in as little as one week. To learn more about this surgery, including the risks, consult your medical provider. Don’t be afraid to speak candidly about your condition, symptoms, and goals for recovery. By doing so, you can ensure that you and your medical provider are on the same page as you take the next steps on the road to recovery.

Disc Extrusion Summary

Disc extrusion is a specific type of spinal disc herniation and refers to a condition where the inner material of the spinal disc (the nucleus pulposus) breaks through the outer fibrous ring (the annulus fibrosus) but remains connected to the disc. Here are some facts about disc extrusion:

Anatomy Involved:
- The spinal disc is composed of two main parts: the inner gel-like nucleus pulposus and the outer, tougher annulus fibrosus. In disc extrusion, the nucleus pushes out through a tear in the annulus but remains tethered to the disc.
Difference from Other Types of Herniation:
- Disc Protrusion: A more common type of disc herniation where the nucleus pushes out without breaking the outermost fibers of the annulus.
- Disc Sequestration: This is when the extruded piece of the nucleus separates entirely from the main disc.
Causes:
- Age: Degenerative changes occur in discs as we age, making them more susceptible to herniation.
- Trauma: A sudden force or injury can cause a disc to extrude.
- Repetitive Strain: Activities that put recurrent pressure on the spine, like heavy lifting, can lead to disc issues over time.
- Genetics: Some people may be genetically predisposed to disc problems.
Symptoms:
- Pain: This can be localized or radiating. For instance, a lumbar disc extrusion might cause sciatica, a sharp pain that travels down the leg.
- Numbness and Tingling: If the extruded disc material compresses a nerve.
- Weakness: In the muscles served by the affected nerve.
- Note: Some people with disc extrusion might have no symptoms at all.
Diagnosis:
- MRI: Magnetic Resonance Imaging is the gold standard for visualizing soft tissues like spinal discs.
- CT Scan: Can be used in some cases.
- Physical Examination: A physician will assess symptoms, range of motion, and neurological function.
Treatment Options:
- Conservative Management: This includes rest, physical therapy, pain medications, and possibly epidural steroid injections.
- Surgery: If conservative treatments fail, or if there’s significant neurological impairment, surgery like a microdiscectomy might be recommended.
Potential Complications:
- If left untreated, a disc extrusion can lead to chronic pain or permanent nerve damage. In rare cases, severe compression can lead to cauda equina syndrome, a medical emergency characterized by lower back pain, paralysis of the leg muscles, loss of bowel and bladder control, and numbness around the groin.
Prognosis:
- Many people with disc extrusion find relief with conservative treatments. If surgery is required, it typically has a high success rate.
- It’s essential to adhere to treatment guidelines and maintain a spine-friendly lifestyle, including proper ergonomics, exercises, and weight management, to prevent recurrence or additional spine issues.

In summary, disc extrusion is a type of disc herniation that, while potentially causing significant pain and neurological symptoms, has a range of effective treatments. Early diagnosis and appropriate intervention are key to a good outcome.

Contact Florida Surgery Consultants About Your Disc Extrusions

If you believe you have symptoms of a disc extrusion, contact Florida Surgery Consultants. We are a group of spine surgeons based out of Tampa, Florida. We can perform minimally invasive spine procedures for disc extrusions with fast recovery times. At Florida Surgery Consultants, we have some of the top rated spine surgeons in Florida. Listed below is the Spine Surgeons in Florida that perform surgeries for disc extrusions: