Lumbar Disk Pain - Blog
Let’s explain the anatomy of that area first...
The lumbar spine is a group of 5 vertebraes localised between 2 rigid regions, the thoracic spine and the sacrum.
Between vertebraes we find the intervertebral disc, made of water and a sponge-like substance, which main function is to cushion the impact, allowing flexibility and providing protection from jarring movements.
Here in the disc, we can observe 2 different substances:
What should we know?
Clinically ‘‘normal’’ (asymptomatic) people may have a variety of harmless imaging findings, including congenital or developmental variations of discs, minor bulging of the annuli, age-related desiccation, anterior and lateral marginal vertebral body osteophytes, prominence of disc material beyond one endplate as a result of luxation of one vertebral body relative to the adjacent vertebral body (especially common at L5–S1), and so on. Therefore, these findings could not provoke ANY symptom. Indeed, normal asymptomatic populations can have a 24-33% frequency of protruded hernias.
Herniated discs may be classified as protrusion or extrusion, based on the shape of the displaced material.
Protrusion: It is present if the greatest distance between the edges of the disc material presenting outside the disc space is less than the distance between the edges of the base of that disc material extending outside the disc space.
Extrusion: It is present if the edges of the disc material beyond the disc space is greater than the distance between the edges of the base of the disc.Sequestration if the displaced disc material has lost continuity completely with the parent disc.Migration may be used to signify displacement of disc material away from the site of extrusion
Okay, I feel throbbing pain down to my leg, I have gone for an MRI and I have been told that I have a “slipped disc”, so… What should I know?
Some studies claim that one of the most important causes of improvement is to shrink the size of the hernia, which happens in a high percentage of untreated hernias.
Nevertheless, conventional wisdom on surgical therapy is based on the roots’ mechanical compression by the disc hernia and this is why if hernia disappears spontaneously, surgical therapy can only be considered in cases where there is a serious deterioration of the patients’ quality of life.
Does the size matter?
The size of a hernia has little relation to its possible disappearance, most studies show there is hardly any relation between the size of a hernia and its persistence or disappearance.
On the histological level, the epidural scar was identical to the one seen on surgical patients and contains a mixture of fibrocytes, collagen and small vessels. Thus, we could expect during the process of scarring the disc fragment to be invaded by granulation tissue that would break, fragment and reabsorb hernia.
To sum up:
Extruded disc hernias usually disappear and shrink; and extrusion is an important predictive factor for shrinking of hernias’ size.
Speed of reabsorption is variable and many hernias reabsorb rapidly.
Conservative treatment is the treatment of choice.
Surgery is only considered in cases where the patients’ quality of life is seriously affected and there is no improvement with conservative treatment.
Bibliography:
Ramos Amador, A., Alcaraz Mexía, M., González Preciado, J. L., Fernández Zapardiel, S., Salgado, R., & Páez, A. (2013). Natural history of lumbar disc hernias: Does gadolinium enhancement have any prognostic value? Radiología (English Edition), 55(5), 398–407.
Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology: recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. 2001;26:E93-E11311242399.
