Disc Protrusion Symptoms and Treatment

Do You Think You Are Suffering From A Spinal Disc Protrusion Or Slipped Disc?

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Case Studies

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What is a Spinal Disc Protrusion or “Slipped Disc”?

The spinal or intervertebral discs separate and allow movement between the vertebrae of the spinal column. They have a soft mobile centre and a wall consisting of some 26 layers. In reality, the term disc protrusion or slipped disc is a ‘catch-all’ term for a range of disc problems where a portion of the disc wall becomes weakened and bulges or ultimately disrupts with the soft “Nucleus Pulposus” extending backwards into the spinal canal and irritating or compressing the descending or exiting nerves. Normally the disc wall stretches causing a disc bulge (protrusion) but the ruptured disc may extrude or a fragment may part company from the disc itself when it is termed a sequestrum.

Where does it hurt?

A disc protrusion or bulge can occur anywhere along the length of the spinal column from the neck to the lower back. The condition may arise in the neck (cervical spine), back of chest (thoracic spine) or lower back (lumbar spine). Medical professionals always use this terminology to ensure strict accuracy of both description and communication and in order to avoid misinterpretation.

How is a disc protrusion diagnosed?

The problem in diagnosing the source of your pain is that conventional diagnosis is inaccurate. Conventional diagnosis relies upon patterns of pain distribution related to disc levels based upon deductions made from inert sources such as X-rays, MRI, CAT, Dexa scans and EMGs (electrical transmission studies in the limbs). Most patients have multiple potential sources of nerve irritation or even compression on their scans – but which one is truly causal.

In the light of prevalent cases of failed conventional back surgery, we rely upon aware state feedback during surgery to guide us to the actual source of the pain and indeed this may emanate from more than one discal level.

The first feature to evaluate is the pattern of the evolving pain and its site. Is this the first episode of pain or is this a recurrent and worsening pattern?

Is the pain in your lower back?

Combinations of pain in the lower back, buttock, groin or leg can arise either from irritation in the disc itself from a high intensity zone , or when the disc causes physical irritation of the adjacent nerves. The pain, which when it spreads below the knee (termed Sciatica) occurs when the disc protrusion or “slipped disc” presses on a nerve in the lumbar spine. This may cause numbness or pins and needles in the leg and be associated with weakness such as “foot drop” (difficulty lifting the toes and foot up) or weakness when pushing off with the foot. Endoscopic aware state surgery has taught us that superficial pressure on a nerve causes pain in the local region of the spine. Referred pain into the arm, chest, flank or leg only occurs when the compression affects the deeper elements of the nerve. This insight is not available to conventional surgeons operating on patients under General Anaesthesia.

Is the pain in your neck?

Neck pain, headaches and pain in the face, shoulders, arms and hands may be created when the disc protrusion or “Slipped Disc” presses on the neck nerves. As compression increases this may cause numbness or ‘pins & needles’ in the face, shoulder, arm or hand and may also be associated with weakness of shoulder, elbow, wrist or hand movements. Any one of these symptoms, or a combination of them, can indicate the presence of a disc protrusion, “slipped disc” with or without enhancement by a high intensity zone.

Is the pain in your chest or abdomen?

Pain radiating round one or both sides of your chest, flank or abdomen may be arising from a disc protrusion or “slipped disc” in the thoracic spine – behind your rib cage. It has to be differentiated from lung problems normally provoked by breathing deeply and intra abdominal complaints. As compression increases this may cause numbness or ‘pins & needles’ around the rib cage or radiating to the umbilicus or lower and may also be associated with weakness of muscle function in the same territory. Any of these symptoms, or a combination of them, can indicate the presence of a disc protrusion, “slipped disc” with or without enhancement by a high intensity zone.

How is the first attack treated?

The major symptoms arising from the first attack generally settle down over the first 6 weeks and half of the remainder will usually settle down over the next 6 weeks. Treatment during this period is focused on reducing the irritation by prescribing: anti-inflammatory drugs (Steroids or Non-Steroidal Anti-Inflammatory therapy - Ibuprofen, Diclofenac , Naproxen or Acemethacin), control of pain with paracetamol and separate Codeine and correcting posture and regaining deep muscle control of the spine by Muscle Balance Physiotherapy. Additional pain control may require Amitryptaline, Nortryptaline or Pregabolin.

How are repeated attacks treated?

Repeated attacks or enduring symptoms need more radical treatment, and these may be grouped in to three treatment pathways; Conservative Therapy, Conventional Open Surgery and Endoscopic Minimally Invasive Spine Surgery. (To see these diagrammatically, please click here for lumbar treatment pathways and here for cervical treatment pathways).

• Conservative therapy consists of Muscle Balance Physiotherapy, CT Guided Nerve Root Block injections, Facet Joint Injections (Caudal Epidurals are only rarely conducted unless for short-term relief) Cognitive Behavioural Therapy and Coping Courses, plus a restricted lifestyle, and the hope that the symptoms will abate over time. Some patients will be offered Dorsal Column Stimulation where the clinician is unable to define the pain source and some patients are left in a wheelchair existence.
• Conventional Open Surgery, carries greater risk than conservative therapy and cannot guarantee success. The surgical options are tabulated below and details of these treatments may be explored through the list on the right.
• Endoscopic Minimally Invasive Spine Surgery (Foraminoplasty) has shown encouraging results in over 80% of 4,950 Foraminoplasties carried out in the Spinal Foundation in patients suffering Slipped discs, Failed Back Surgery, Failed Fusion Surgery, “Instability”, Spondylosis and Back pain, Lateral Recess Stenosis and Axial Stenosis, Spondylolytic Spondylolisthesis and Disc infections. 10 years from Foraminoplasty, 72% were successful. 50% of this group suffered from failed back surgery.