Protrusion of intervertebral discs ✔: symptoms, signs and causes, diagnosis and treatment

The vertebrae L3 and L4 belong to the lumbar spine. In total there are 5 vertebrae, which are large in size. Between them are cartilaginous formations called intervertebral discs. Each of them has a dense fibrous ring, which is its outer shell and consists of annular fibers, as well as a nucleus pulposus. It is a gel-like mass that is responsible for cushioning shocks when walking, doing physical work, as well as ensuring flexibility and mobility of the spine.

Protrusion is the protrusion of the intervertebral disc, but while maintaining the integrity of the fibrous ring. Damage to the L3-L4 disc, located between the 3rd and 4th lumbar vertebrae, is uncommon, but does occur. In most cases, this is combined with other pathologies of the spine, including protrusion of the L4-L5 intervertebral disc, as well as antelisthesis, retrolisthesis, etc.

Description of the disease

Intervertebral discs are elastic pads between the vertebrae that provide shock absorption and flexibility to the spinal column. They consist of a jelly-like core surrounded by a fibrous fibrous sheath. As osteochondrosis progresses, there is a gradual narrowing of the space between the vertebrae, as well as disruption of the nutrition of the discs. As a result, the outer shell becomes thinner and begins to bulge under the pressure of the core. A protrusion is formed, which, if left untreated, will turn into a hernia (if the fibrous ring ruptures).

The most common protrusions of discs located in the lumbosacral spine, since this area is subject to the greatest load when the body is in an upright position. In second place in terms of frequency of occurrence are protrusions of the cervical spine.

Protrusion of the lumbar and sacrum

Bulging can occur in any sector of the spine, but the lower back and sacrum are especially susceptible to this pathology, since the design of the spine and the structure of the human body cause increased load on this area. And although all the zones into which the spine is divided are interconnected, each of them has certain configuration features and segment structure.

By the way. The lumbar region receives the largest amount of load that the human spine experiences throughout life. It is distinguished by larger vertebrae than other zones. This is where injuries most often occur and pathological processes arise, almost always affecting the adjacent sacral zone.

Causes

The most common cause of protrusions is osteochondrosis. Without treatment, degenerative processes in cartilage tissue inevitably lead to damage to disc pathology. Predisposing factors are also:

spinal column injuries;
poor posture, scoliosis;
increased load on the spine: frequent lifting of heavy objects, excess body weight, pregnancy;
weakness of the back muscle corset due to congenital disorders or lack of physical activity;
regular vibration loads on the spinal column;
undergone surgery to remove an intervertebral disc (the load on neighboring areas increases);
sudden movements that go beyond what is usual for a person;
infections of the spine or surrounding tissues.

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What is posterior circular protrusion (circular-dorsal protrusion)?

Posterior circular protrusions of the discs are directed towards the back. If the deformation is significant, then the likelihood of damage to the spinal tissue increases.

The main danger of this pathology is that it is asymptomatic for a long time. The disease makes itself felt after it begins to have a mechanical effect on the nerve fibers.

Violation of the innervation of internal organs leads to changes in their functioning. Damage to the spinal cord can lead to paralysis.

A hernia formed due to posterior circular protrusion is difficult to treat. Surgery is associated with a high risk of complications.

Kinds

Spinal disc protrusions are classified depending on the direction of the protrusion. The following options are available:

median: the protrusion area is located in the central part of the spinal canal; often accompanied by neurological disorders;
paramedian: a protrusion forms on the right or left relative to the spinal canal, often causing pinching of the nerve roots and severe pain;
foraminal: the formation is located in the natural openings between the vertebrae, where the nerve roots pass; even with a small defect volume they cause significant neurological impairment and pain;
diffuse: evenly distributed over the entire back side of the disc.

Symptoms

Most types of protrusions are asymptomatic for a long time. The first signs of pathology appear only when the formations begin to put pressure on the nerve roots.

The most noticeable manifestations are:

pain: intensity and duration depend on the size and location of the protrusion; there are both acute, strong, but short-lived attacks, and prolonged, aching pain;
radicular syndrome can manifest itself as a violation of sensitivity, motor function, functioning of internal organs, as well as a combination of various malfunctions depending on the type of protrusion.

Protrusion in the lumbar and sacral region

This is the most common localization of the pathological process. The epicenter of pain is located in the lumbar region, but the sensations often radiate to the buttock, leg or abdomen. When moving, the pain intensifies, and pronounced muscle spasm develops. Nerve root damage usually manifests itself:

nagging pain in the leg;
pathological sensations (paresthesias) - a burning sensation, numbness, crawling sensations in the legs or groin area;
decreased muscle strength and weakened reflexes on the affected side.

Protrusion in the cervical spine

The characteristic symptoms of this pathology are:

aching or sharp pain in the neck, which increases significantly with movements and attempts to turn the head; sensations can spread to the back of the head, shoulder, arm;
severe spasm of the neck muscles, which makes turning the head difficult;
tingling, burning in the hand on the affected side, weakening of muscle strength and reflexes;
headaches, dizziness.

Protrusion in the thoracic region

It is extremely rare due to the relatively low mobility of this area and the low load on it. Typically, protrusions form against the background of injuries and are accompanied by pain and discomfort when breathing, and a feeling of lack of air. If the protrusion is located in the lower part of the thoracic region, it can affect the functioning of the pelvic organs, intestines, and the menstrual cycle in women.

What it is?

Circular disc protrusion is its partial exit beyond the intervertebral space. The protrusion is circular and uniform, it is not accompanied by a violation of the integrity of the fibrous ring. Since its rupture does not occur, but there is deformation, this type of protrusion is considered the initial stage of hernia formation.

The dimensions of the protrusion vary between 4-11 mm, the extension beyond the intervertebral space does not exceed 1 mm.

Extrusion of the L5-S1 disc is considered especially dangerous. It connects the last lumbar and first sacral vertebrae. In this place there is a nerve bundle that is responsible for the functioning of the pelvic organs and lower extremities. Damage to it can lead to serious complications.

Most often, protrusion occurs in the lumbar spine; the cervical and thoracic segments are less frequently affected. High-risk groups include:

Persons who have suffered spinal injuries.
People leading a sedentary lifestyle.
Patients with spinal curvature.
People suffering from dysmetabolic diseases.

Although protrusion does not cause significant pain, it should be identified at an early stage of development. This will prevent it from transforming into a hernia.

Diagnostics

A neurologist diagnoses protrusions of intervertebral discs. The set of mandatory examinations includes:

interview to identify chief complaints, history of symptoms, and identification of possible causes and risk factors;
neurological examination: assessment of sensitivity, muscle strength, symmetry and severity of reflexes;
visual diagnostics: x-ray, CT or MRI; the clearest result is obtained by MRI, which well visualizes not only bone structures, but also soft tissues of varying densities and allows you to clearly see the disc shape disorder;
Doppler ultrasound of the vessels of the neck and brain in case of damage to the cervical spine: allows you to identify blood supply disorders caused by muscle spasms;
examinations to exclude other pathologies with similar symptoms: general blood and urine tests;
blood chemistry;
ECG, daily ECG monitoring;
Ultrasound of the abdominal organs;
MRI of the brain;
chest x-ray;
consultations with a gynecologist, cardiologist, pulmonologist and other specialists depending on the manifestations of the disease.

The full list of examinations depends on the specific symptoms and their severity, chronic diseases and other characteristics of the patient’s body.

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Classification of pathology and signs by type

Yes, physiological processes associated with aging are a significant factor in the formation of vertebral protrusions. But in many cases the process does not depend on the patient’s age or gender. The cause is a variety of pathologies.

By the way. In order to prescribe precise therapy after identifying the disease, the doctor must find out the type of disease and determine the cause that triggered its occurrence.

In the classification of protrusions, there are several types of pathology, which are considered the most common and dangerous. The most serious of them is dorsal protrusions.

Types of protrusions

With these types, the disc nucleus, protruding, presses on the spinal canal, pinching its cavities and nearby nerve fibers. The displacement is carried out in the rear direction.

Dorsal protrusion

When a dorsal protrusion forms in the L4 - L5 vertebrae, the disease has the following symptoms:

pain occurs in the lumbar girdle, radiates to the hip joints, buttocks, along the entire leg or both;
movement is felt stiff;
areas of the body located below the lower back lose sensitivity;
your ankles go numb and your toes tingle at times;
blood circulation is disrupted;
organs whose activity is affected by pinched nerve endings are destabilized.

Dorsal protrusion of the intervertebral disc

If the protrusion occurs in the vertebrae L5 - S1, the signs will be as follows:

pain directly at the site of the lesion;
pain radiating to the intercostal area;
pain syndrome that occurs in the occipital region, throughout the head, especially when moving;
numbness of the shoulder girdle, arms, fingers;
sudden fluctuations in blood pressure.

By the way. Most of these signs are not specific and can be characteristic of many other diseases that are not related to the spine. Some are caused by fatigue or viral diseases. Therefore, the diagnosis of protrusions is often untimely, difficult, and the wrong disease is treated.

Dorsal protrusion comes in several varieties.

Foraminal view.
Median view.
Diffuse appearance.

General view of the spine and vertebral designations

The latter differs in that the disc protrudes unevenly and in many places.

Treatment of disc protrusion

Treatment of the cervical, thoracic or lumbar spine is aimed primarily at eliminating symptoms. Medications that come to the fore include the following groups of drugs:

analgesics and non-steroidal anti-inflammatory drugs (analgin, diclofenac, ibuprofen, etc.): aimed at relieving inflammation and pain relief; prescribed in the form of tablets, ointments, patches, suppositories or in injection form;
glucocorticosteroids (hydrocortisone, dexamethasone, etc.): used when milder agents are insufficiently effective; used orally, topically or by injection, including for blockades;
narcotic painkillers (tramadol, morphine): necessary for extremely severe pain that cannot be relieved by other drugs;
muscle relaxants (baclofen, mydocalm): relieve muscle spasms that occur due to compression of the roots;
anticonvulsants (pregabalin): help relieve radicular syndrome and muscle spasms;
chondroprotectors (chondroitin, rumalon): promote partial restoration of cartilage tissue in osteochondrosis;
B vitamins (milgamma): help improve the conduction of impulses along nerve fibers, necessary for radicular syndrome.

Non-drug treatment helps relieve pain more quickly and also prevents recurrent attacks of the disease. Depending on the clinical situation, the following are used:

regimen: during an exacerbation, it is recommended to minimize the load on the spinal column and wear a special support corset or collar;
physiotherapy: magnetotherapy, DDT, laser treatment, electrophoresis, phonophoresis;
spinal column stretching, underwater traction: helps relieve stress;
massage and manual therapy: relieve muscle spasms, help strengthen the muscle frame;
physical therapy: prescribed outside of exacerbation, helps reduce body weight and strengthen muscles;
spa treatment: prescribed during the period of remission.

Modern methods of surgical treatment make it possible to do without incisions and stitches. Interventions are carried out through small punctures and are aimed at complete or partial destruction of the nucleus. Depending on the situation, the following are used for this purpose: laser, radio frequency exposure, strong liquid pressure, etc.

Surgery for lumbar hernia L3–L4

Surgical intervention is a last resort measure necessary in the absence of positive changes in the patient’s condition during conservative treatment carried out for more than 1–3 months. It is also prescribed to patients whose MRI images show an intervertebral hernia of L3–L4 greater than 12 mm or severe pain, even if the size of the protrusion is small.

In certain situations that threaten serious complications, emergency surgery is required. We are talking about sequestered hernias. But such interventions are the most technically complex and require maximum care and skill from the neurosurgeon.

Removal of L3-L4 disc herniation is possible today by:

nucleoplasty;
endoscopic surgery;
microdiscectomy.

These operations to remove L3–L4 intervertebral hernia differ not only in price. The main difference is the indications for their implementation and the existing limitations. Therefore, the technique is selected separately for each patient.

All types of modern surgical interventions for the removal of intervertebral hernias have in common a low degree of risk, a good cosmetic effect and a short rehabilitation period, but only if an experienced neurosurgeon is selected.

After endoscopic surgery and microdiscectomy, a disc defect occurs and sometimes it is necessary to remove it completely. In the first case, the Barricaid mesh implant is used to prevent relapse. The second requires the use of a transpedicular fixation technique or the installation of an M6 prosthesis.

Nucleoplasty

The most modern technique for removing intervertebral hernia of the lumbar region L3–L4 is nucleoplasty. It can be performed through the use of various techniques, on the basis of which they distinguish:

laser nucleoplasty;
cold plasma nucleoplasty;
radio wave nucleoplasty;
hydroplastics.

Hydroplasty using the SpineGet device is considered one of the most effective and safe techniques. The essence of the method is to introduce a special thin instrument into the nucleus pulposus through a pinpoint puncture of soft tissue. A saline solution is pumped through it under pressure, which leads to mechanical destruction of part of the gelatinous contents of the disc. At the same time, the liquefied material is pumped out, which creates all the conditions for the protrusion to be retracted and pain eliminated.

Nucleoplasty is possible for uncomplicated hernias up to 7 mm in size. The postoperative wound does not require suturing. It is covered with a sterile bandage.

Relief occurs almost immediately or the patient’s condition gradually improves over 2 weeks. A huge advantage of puncture surgery is the absence of the need for hospitalization and complex rehabilitation, so the patient can independently leave the clinic a few hours after surgery.

Endoscopic surgery

Removal of a hernia using endoscopic equipment is carried out through a pinpoint puncture of soft tissue, up to 1 cm in diameter. A hollow endoscope equipped with a video camera is inserted through it, which transmits the image to the monitor. Through the endoscope, the surgeon inserts a special manipulator with which he can resect the protruding part of the disc.

Endoscopic surgery is possible for large hernias, as well as those located in the foraminal openings or other narrow areas of the spinal canal. Because access to the disc is created using a shaver, the risk of nerve damage is dramatically reduced.

Microdiscectomy

Microdiscectomy is a microsurgical operation performed through an incision of up to 3 cm. It is performed in the presence of neurological disorders or in the diagnosis of a sequestered hernia, since it is impossible to completely remove it in a less traumatic way.

Prevention

Compliance with preventive measures is important both for people who have already identified protrusions, and for those who do not want to allow them to appear. Rules include:

compliance with the work and rest regime, avoiding physical overload;
regular exercise (without striving for records), walks in the fresh air;
exclusion of sports associated with jumping, vibration, lifting weights (equestrianism, weightlifting, etc.);
correct posture when sitting and walking;
nutritious nutrition with sufficient amounts of vitamins and minerals, especially calcium and collagen;
normalization of body weight if it is excess;
sleep on a high-quality orthopedic mattress and comfortable pillow;
regular examinations by a doctor, elimination of chronic diseases.

Clinical picture

In most cases, in the initial stages, circular protrusion is asymptomatic. If during the process of protrusion the intervertebral disc does not put pressure on the spinal nerves and/or blood vessels, then the disease does not manifest itself in any way. As a rule, it can be detected by chance during a comprehensive medical examination using instrumental diagnostic methods. The disease begins to manifest itself only when compression of nerves and blood vessels occurs. What clinical picture is observed:

Quite intense pain in the lower back, radiating to the leg.
The pain increases significantly with physical activity.
Impaired sensitivity in the lower extremities (feelings of numbness, tingling, etc.).
Weakness in the legs.
Problems with the functioning of the colon and bladder.
Knee reflexes decrease.

The clinical picture of circular protrusion of L3–4 may resemble an intervertebral herniation at a similar level.

Treatment at the Energy of Health clinic

Neurologists at the Energy of Health clinic will come to the rescue both at the first signs of protrusion and at an advanced form of the disease. We will conduct a comprehensive diagnosis to accurately determine the type and degree of pathology, and also prescribe adequate and effective treatment, including:

modern drug regimens for high-quality pain relief and elimination of radicular syndrome, including injections of long-acting agents;
drug blockades for quick pain relief;
physiotherapy, massage and manual therapy in the absence of contraindications;
physical therapy directly in the clinic, as well as drawing up a daily home workout plan;
organization of sanatorium-resort treatment during remission.

Advantages of the clinic

The Health Energy Clinic works so that every patient can receive qualified medical care in the shortest possible time at an affordable price. At your service:

experienced and skilled medical personnel who regularly improve their knowledge;
the opportunity to get advice from foreign experts (via the Internet);
modern diagnostic equipment;
all types of laboratory tests;
medicinal and surgical treatment methods, physiotherapy, massage, exercise therapy, chiropractor services;
individual approach to the selection of therapy;
organization of sanatorium-resort treatment;
procedures in a day hospital;
assistance in hospitalization in other hospitals in the city;
issuing the necessary certificates, conclusions and certificates of incapacity for work.

Disc protrusion seems like a minor problem compared to other diseases, but it can cause severe pain and unpleasant disorders. Do not bring the disease to its extreme stage, get diagnosed and treated at Health Energy.