Extrusion is one of the stages in the development of intervertebral hernia. And today, many people are faced with a similar diagnosis. That is why patients are interested in information about the causes, symptoms and modern methods of treatment for this condition.
What is extrusion?
Quite a few patients today face a similar diagnosis. And many people think that extrusion is a hernia. In fact, such a statement is not entirely true. Indeed, extrusion is, rather, the initial stage of the formation of a hernia of the
intervertebral disc. What is observed with a similar disease?
Surely many industrial workers are familiar with this term. Indeed, in production, the extrusion method is the process of obtaining materials from a polymer in which the melt is extruded through a special hole. In this case, we can draw some analogies.
In medical terminology, extrusion is a condition in which the fibrous ring of a disk ruptures and a pulpous nucleus prolapses outward. The latter at the same time reaches 3-4 mm (it hangs like a drop of water) and irritates the nerve roots.
Stages of intervertebral hernia formation
In order to understand what extrusion is and what its role is in the formation of an intervertebral hernia, the whole process should be considered.
The hernial protrusion is formed in three stages. To begin with, there is a so-called prolapse, in which the substance of the intervertebral disc falls outside the functional segment without breaking the fibrous ring. Due to lack of water and nutrients, the mobility of the pulp nucleus is significantly reduced.
In the future, a second stage is observed, which in modern medicine is called protrusion. In this case, the intervertebral disc is displaced by 3-4 mm (sometimes up to 15 mm) beyond the vertebrae.
Extrusion is the third stage in the formation of protrusion. At this stage, a rupture of the fibrous ring and the exit of the substance of the nucleus beyond the vertebra are observed. In most cases, strong compression of the nerve roots is not observed, since the nucleus is restrained by the longitudinal ligament of the spine. If we are talking about extrusion in the lumbar and sacral regions, then the disease can be more dangerous, since it often causes compression of the sciatic nerve.
Extrusion and its varieties
In modern medicine, there are several classification systems for various vertebral diseases. For example, extrusion is often divided into types depending on the direction in which the pulpous nucleus falls.
For example, if the substance of the nucleus extends beyond the sides of the spinal column, then this form of the disease is called lateral. There is dorsal extrusion of the disc, which is accompanied by a protrusion towards the soft tissues of the back. Often, patients are faced with other diagnoses. For example, some people are interested in questions about what is central or paracentral extrusion of a disc. With this form of the disease, the substance of the nucleus does not protrude outward, but inside the spinal column, which is extremely dangerous, since there is always the possibility of compression of the spinal cord. There is also a posterolateral form of the disease, in which protrusions are observed in the back and on the sides.
Sometimes a doctor makes a diagnosis of "subligamentary disk extrusion." What it is? In this case, the name says not about the direction of the protrusion of the substance, but about the stage of development of the disease. If at the initial stages the cartilaginous tissue of the nucleus is displaced, but still retained due to the posterior longitudinal ligament, then in this case, damage to the ligament and the formation of subglottic extrusion are observed.
The main reasons for the development of extrusion
In fact, there are many reasons for the development of such a disease. First of all, it should be noted that extrusion is a disease of old age. Indeed, in the process of aging, tissues gradually lose water, there is a violation of blood supply, etc. Thus, the intervertebral discs also become less elastic.
However, there are some other reasons. For example, extrusion often develops against the background of various degenerative diseases of the spinal column. For example, spondylosis, osteochondrosis or curvature of the spine quite often cause extrusion, and then a hernia.
Of course, injuries to muscles and ligaments can be attributed to the list of causes. In addition, such a disease is often the result of prolonged and excessive physical exertion, especially when it comes to damage to the intervertebral discs in the lumbar and sacral regions, which are most often amenable to injuries and bear the brunt of the movement.
What are the symptoms of the disease?
In fact, disk extrusion is far from always accompanied by some obvious and noticeable symptoms. Quite often, the disease is hidden. Pain and other signs appear only if the core that extends beyond the fibrous ring presses and irritates the nerve roots. And the clinical picture in this case depends on which
part of the spine was affected.
With a problem in the cervical region, pain in the shoulders is observed. Often she gives to the elbows, forearms and fingers. Extrusion of the thoracic disc can be accompanied by a malfunction of some internal organs, as well as pain in the chest area.
The most characteristic picture is observed with lesions of the lumbar region. As a rule, patients complain of pain in the thigh or leg, as well as numbness or tingling in the lower extremities, toes. Extrusion of the sacral region may be accompanied by pain in the tailbone, pelvic area, and genitals.
Modern diagnostic methods
Of course, first you need a doctor's examination. Indications for further examination are the patient’s history, clinical picture (the presence and localization of pain, its intensity), some neurological disorders (for example, the absence of a knee or Achilles reflex, the appearance of pain during examination of the spinal column).
As a rule, magnetic resonance or computed tomography is assigned to begin with, which makes it possible to confirm the presence of protrusion and accurately determine its size and location. In some cases, a contrast study is performed, in which a special substance is injected into the spinal canal. Such testing makes it possible to determine the structure of the prolapse (this is extrusion, protrusion or hernia).
Is conservative treatment possible?
Of course, extrusion of the disc in most cases can be cured using conservative methods of medicine, especially if the protrusion does not exceed 5-7 mm. In this case, the doctor will most likely recommend adjusting the diet and reducing physical activity. For patients suffering from obesity, it is extremely important to normalize weight, as this will relieve pressure on the spine and other joints.
Physiotherapy is also required. The patient is obliged to regularly engage in special exercises that will help strengthen the muscle corset, which, again, will reduce tension in the spine.
As for drugs, in some cases it is hardly possible to do without them. With severe pain, appropriate drugs are prescribed. In the presence of inflammation, patients usually take non-steroid drugs. But with severe inflammation and intense pain, doctors can recommend steroids that are injected directly into the epidural space of the spinal cord.
Surgical Therapies
In the event that the extrusion exceeds 12 mm, outpatient treatment is rarely prescribed, since conservative therapy can only worsen the situation. In such cases, as a rule, the possibilities of modern surgery are used.
Sometimes patients are prescribed discectomy - a minimally invasive operation in which all the manipulations are carried out using endoscopic instruments. In addition, laser correction of intervertebral discs is possible.
Possible extrusion complications
Extrusion is a rather dangerous disease. Therefore, in no case should you refuse treatment or ignore the recommendations of doctors. Indeed, as the disease progresses, the pulpous nucleus will come out more, squeezing the roots, thereby increasing soreness and worsening the quality of life.
On the other hand, the lack of timely therapy is fraught with the development of intervertebral hernia. And if conservative treatment is possible during extrusion, a hernia in almost every case requires surgical intervention.