Dorsal disc protrusion is a condition in which a damaged spinal disc, having lost the amount of fluid it needs to function, falls outside the vertebral body.
“Dorsal” protrusion is called because the disc protrudes dorsally, i.e. posteriorly, to the side where the spinal canal with the dura mater, spinal cord and spinal nerves is located. Protrusion is the process of destruction of the intervertebral disc and is the initial stage of development of a herniated disc.
Dorsal disc protrusion - what is it?
There are a large number of factors leading to the destruction of the intervertebral discs of the spine, but no matter what the reason or combination of reasons is the cause of the destruction, there is always a fairly typical algorithm for the damage and destruction of the intervertebral disc.
First of all, cracking of the outer shell of the disc (fibrous ring) occurs, as well as a parallel progressive loss of fluid from the central pulpous nucleus of the disc, without which the disc is not able to perform its functions.
The result of the disc losing fluid from the nucleus pulposus is a decrease in its shock-absorbing properties and it is squeezed out. Thus, a protrusion is formed directed towards the spinal canal area.
Complications and consequences of the disease
If left untreated, a diffuse hernia is dangerous due to rupture of the fibrous ring and gradual destruction of the intervertebral disc. The patient develops acute pain syndrome and decreased motor activity. Further progression of the disease causes paresis, paralysis and disability.
Rupture of the fibrous ring.
Mechanism of occurrence
In the lumbar and cervical spine, the pulpous nuclei of the intervertebral discs (if you look at the spine from the side) are not located strictly in the middle, but are shifted somewhat posteriorly in order to create the correct physiological curves in the spine - cervical and lumbar lordosis.
That is why, when the height of the disc decreases, which occurs when it is destroyed, part of the disc with the nucleus begins to be squeezed out mainly posteriorly, i.e. dorsally.
This condition is provoked by particular inclined positions of the torso (working “inclined”) or head (working at a computer).
Straightening the physiological curves in the cervical and lumbar spine is also of great importance, which very often happens with osteochondrosis.
In the thoracic spine, where the nuclei pulposus are somewhat displaced anteriorly, dorsal protrusions are much less common.
Classification
Doctors divide intervertebral hernias into several types, differing in the methods of manifestation and location. There are also several types of dorsal disc herniations, which have different types of damage and the direction of the pathological process towards the spinal cord.
Dorsal disc herniation on MRI
Table. Main types of dorsal hernias.
| Type of hernia | Description |
| Paramedian | It appears as a slight protrusion of the disc to the side. In this case, only part of the spinal cord canal is affected. |
| Medial-paramedial | A type of pathology in which the vector of protrusion is directed to the right or left relative to the central axis of the spinal canal. |
| Foraminal | It is distinguished by the presence of access to special canals - foraminal. In this case, the roots of the spinal nerves are affected in the same way as in other types of pathology. |
| Dorsal medial | A common disease that affects the central part of the patient's spinal cord. In this case, discs l4 and l5 undergo pathological changes. |
| Dorsal diffuse | The disease is accompanied by damage to the entire surface of the spinal disc. At the same time, there are no pronounced tissue damage. |
Dorsal diffuse protrusion
All types of intervertebral hernia are dangerous for the body in their own way, so when diagnosing them, immediate medical attention is required.
If you would like to learn more about how to treat dorsal disc extrusion, as well as consider alternative treatment methods and prevention, you can read an article about it on our portal.
Symptoms
Symptoms of dorsal protrusions depend on the direction of extrusion of the protrusion.
- If the protrusion is directed strictly posteriorly , then it causes muscle tension, irritating the posterior longitudinal ligament running along the edge of the vertebra. With loads, heavy lifting, or working in a forced position of the torso, already formed muscle tension can increase many times and manifest itself as pain. Depending on the degree of disc destruction, pain can be strong or weak, be present for a long time after the exercise itself, or pass quickly.
- If the protrusion is shifted slightly to the side from the central line , then the extruded intervertebral disc is close to the nerve emerging from the spinal cord. In this case, with the development of inflammation or swelling, the dorsal protrusion will take part in irritation and/or compression of the nerve, causing pain that will not only be located at the site of inflammation, but also spread to the periphery (to the shoulder, arm, buttock, thigh or leg). In this case, the pain can be quite severe and long-lasting, and it will be difficult to distinguish it from a progressive herniated disc.
Clinical manifestations of paramedian hernias
The initial stages of the disease are characterized by mild symptoms, which are expressed in dull and aching pain due to fatigue. If you do not contact the multidisciplinary CELT clinic for treatment in time, intense pain syndrome may occur, which will be accompanied by:
- disruption of the functioning of internal organs;
- impaired motor function of the arms and legs.
When a C6-C7 disc herniation occurs, the following clinical manifestations are observed:
- pain in the place where the hernia developed;
- migraine-like headaches;
- deterioration of vision and hearing;
- numbness of fingers and hands
Diagnostics
Dorsal protrusion can be objectively diagnosed only with an MRI or computed tomography examination. Radiographs do not show posterior protrusions.
On Rg images, dorsal disc protrusions can be judged only on the basis of indirect signs.
Since it is very difficult to distinguish a dorsal protrusion from a formed spinal hernia based on complaints and symptoms, all patients who first complain of pain in the spine must undergo an MRI examination, this will allow identifying the protrusion at an early stage of development, which means timely treatment aimed at curing it. .
Diagnostic measures
To make an accurate diagnosis, it is necessary to conduct a diagnostic examination. For this purpose, various instrumental diagnostic methods are used, the most effective of which is magnetic resonance imaging (MRI) . Based on its results, the doctor will be able not only to identify the protrusion and its direction, but also to assess the size of the pathological focus and the degree of compression of the spinal canal.
Magnetic resonance imaging
There is a good alternative to MRI - computed tomography (CT) . It is carried out in cases where a more effective and expensive procedure is not possible. Based on the results of a CT scan, a specialist can only identify a hernial protrusion. Also, during the diagnostic examination, the patient may be prescribed an X-ray examination, but this method is less informative - with the help of an X-ray, the doctor will be able to exclude the presence of other sources of pain, for example, malignant tumors, spinal injuries or curvatures. Based on the results of the procedures performed, an appropriate therapeutic course is prescribed.
Image of a hernia on a tomograph
Treatment of dorsal disc protrusion
Correct treatment of dorsal disc protrusion in its tactics usually differs little from the treatment of intervertebral disc herniation.
Since the main problem in the development of dorsal (i.e., posterior) disc protrusion is damage to the posterior parts of the intervertebral disc with its extrusion into the spinal canal, the main basic treatment must necessarily be aimed at this particular damage. For proper treatment of dorsal protrusion of the spine, it is first necessary to carry out a “preparatory” stage of treatment, the task of which is to remove pain, the inflammatory process, relieve increased muscle tone, swelling, eliminate the lack of blood supply to the spinal tissues in the disease areas, after which the main, “restorative” stage treatment. The task of the “restorative” stage of treatment is to heal damage to the outer fibrous ring of the disc and restore the nucleus pulposus of the disc, without which the intervertebral disc will not be able to fulfill its shock-absorbing properties and, in this case, will still remain squeezed out.
The method of treatment of dorsal protrusions used in the clinical diagnostic Center of Dr. Yavid takes into account not only all the symptoms of the disease, but also all the reasons leading to its appearance.
The most innovative and effective technique used at Dr. Yavid’s clinic today is the “revitalizing” technique, aimed not only at relieving symptoms, but also at permanently restoring damaged intervertebral disc tissue.
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Surgery
If conservative treatment methods do not produce the desired effect, doctors resort to surgery. According to statistics, surgery is performed in every fifth case of dorsal hernia. To get rid of protrusion, various surgical methods are used, the most effective of which include microdiscectomy, endoscopy and laminectomy. Let's consider each of the methods separately.
Surgery
Microdiscectomy
The essence of this method is to surgically remove part of the hernia that has formed. In rare cases, the doctor performs a resection of part of the patient's vertebra. A microdiscectomy is performed under a microscope, and a few days after the hernia is removed, the patient is allowed to perform simple work. If all medical recommendations are followed throughout the rehabilitation period, full restoration of working capacity returns in approximately 20 days.
Prevention
The main problem of prevention for posterior disc protrusions is maintaining proper muscle tone and posture. This may involve playing sports, therapeutic exercises or yoga.
This is especially important if the patient has a curvature of the spine (scoliosis). It is advisable to avoid prolonged positions with the torso tilted forward and the head tilted forward, since it is these loads that primarily provoke the formation of posterior disc protrusions.
If you experience even minimal complaints from the back, lower back or neck, you should definitely consult a doctor who specializes in spine diseases. The sooner protrusion is diagnosed and the sooner treatment is started, the more effective and quick the treatment result will be.