i saw your explanation of a protrusion....

[Guest guest]

my mri says i have a " disc extrusion " at L2-L3 area......what is a extrusion and

is that different from a protrusion.....

[Guest guest]

davncar wrote:

> my mri says i have a " disc extrusion " at L2-L3 area......what is a extrusion

and is that different from a protrusion.....

All:

Here is an lengthy but informative description of both - along with other

questions that have been asked. I copied and pasted the information as I don't

think some people will go to the link, but this question and others come all the

time about discs and I got this information by typing in extrusion vs protrusion

of discs.

ver a lifetime the disc can be damaged by acute injuries like auto accidents and

falls or by chronic insult like poor posture, weak and inflexible supporting

muscles, and poor body mechanics. These injuries can cause the annulus, the

outer layer of the disc, to tear.

I had fissures throughout my discs that were not found until they did a

discogram and thin sliced CT scans afterwards. This was the only way to make

sure discs were causing my pain. This is the best site I have found:

http://www.youcanbefit.com/disc.html

This site also discusses treatment and other options.

About Discs:

A disc bulge means that contour of the outer rings (annulus) extends, or appears

to extend, in the horizontal (axial) plane beyond the edges of the disc space,

over greater than 50% (180 degrees) of the circumference of the disc and usually

less than 3mm beyond the edges of the vertebral body apophyses. SOURCE: American

Journal of Neuroradiology: Nomenclature and Classification of Lumbar Disc

Pathology

A disc bulge is due to tears in the annulus allowing disc material to enlarge

the disc in the form of a bulge; similar to the way an old tire might bulge out.

Think of it as a slow leak.The nucleus (jelly like middle) of the disc " squirts "

through some of the torn annular fibers, but not through all the fibers. This

bulge may press straight back or to either side, depending on location of the

annular tears. A bulge may or may not cause symptoms.

A disc herniation is a " localized displacement of disc material beyond the

normal margins of the intervertebral disc space. " " Herniated disc generally

refers to displacement of disc tissues through a disruption in the anulus. "

" Herniated disc is sometimes referred to as " herniated nucleus pulposus, " but

the term herniated disc is preferred because displaced disc tissues often

include cartilage, bone fragments, or anular tissues.

The term " ruptured disc " is used synonymously with herniated disc, but is more

colloquial and can be easily confused with violent, traumatic rupture of the

anulus or end-plate. " " The term herniated disc does not infer knowledge of

cause, relation to injury or activity, concordance with symptoms, or need for

treatment. " Think of a disc hernition as a tire blow-out.

SOURCE: American Journal of Neuroradiology: Nomenclature and Classification of

Lumbar Disc Pathology

The term prolapsed disc has also been used as a general term for disc

displacement, but its use has been inconsistent. " Medically, it usually means to

fall out and down, as with prolapse of the rectum or uterus. Analogy to the disc

would apply most closely to disc tissue that has displaced beyond the disc space

into the supra-pedicular zone. It has been used often, non-specifically, as

synonymous with herniation. Prolapse is not a recommended term for description

of disc displacement. "

SOURCE: American Journal of Neuroradiology: Nomenclature and Classification of

Lumbar Disc Pathology

A protruded disc is " disc in which disc tissue beyond the disc space is

contained within intact anulus. " " A disc that has broken through the outer

anulus at the apex, but maintains a broad continuity at the base, is protruded

and uncontained. While sometimes used as a general term in the way herniation is

defined here, the use of the term protrusion is best reserved for

sub-categorization of herniations meeting the above criteria. " The outer ring of

the annulus has not been breached, in other words, no disc material has

completely squirted through the outer edges of the disc.

SOURCE: American Journal of Neuroradiology: Nomenclature and Classification of

Lumbar Disc Pathology

An extruded disc, or transligamentous disc ( " displacement of disc material

through the posterior longitudinal ligament " ) occurs when the annulus tears all

the way through and some disc material actually pushes out beyond the boundaries

of the disc and nearby ligaments, but has not broken away from the disc itself.

" The preferred definition is consistent with the common language image of

extrusion as an expulsion of material from a container through and beyond an

aperture. Displacement beyond the outer anulus of disc material with any

distance between its edges greater than the distance between the edges of the

base distinguishes extrusion from protrusion.

Distinguishing extrusion from protrusion by imaging is best done by measuring

the edges of the displaced material and remaining continuity with the disc of

origin, whereas relationship of the displaced disc material to the aperture

through which it has passed is more readily observed surgically. Characteristics

of protrusion and extrusion may co-exist, in which case the disc should be

subcategorized as extruded. Extruded discs in which all continuity with the disc

of origin is lost may be further characterized as sequestrated. Disc material

displaced away from the site of extrusion may be characterized as migrated. "

SOURCE: American Journal of Neuroradiology: Nomenclature and Classification of

Lumbar Disc Pathology

Finally, a sequestered or sequestrated disc " is an extruded disc in which a

portion of the disc tissue is displaced beyond the outer anulus and maintains no

connection by disc tissue with the disc of origin. " It occurs when the herniated

disc material completely separates from the disc and becomes a free fragment,

which floats around, just like a loose piece of cartilage in the knee.

" If even a tenuous connection by disc tissue remains between a displaced

fragment and disc of origin, the disc is not sequestrated. "

SOURCE: American Journal of Neuroradiology: Nomenclature and Classification of

Lumbar Disc Pathology

Two other general terms are used when describing disc herniations: contained and

uncontained. The distinction is important because contained disc herniations

generally will respond well to conservation care (chiropractic adjustments and

exercise rehabilitation) while uncontained disc herniations may not. A contained

disc is " displaced disc tissue that is wholly within an outer perimeter of

uninterrupted outer anulus or capsule. " In other words, no blow-out.

SOURCE: American Journal of Neuroradiology: Nomenclature and Classification of

Lumbar Disc Pathology

An uncontained disc is " displaced disc material that is not contained by

uninterrupted outer anulus. " Uncontained disc herniations need surgical

intervention, while in the case of contained discs; conservative care should be

tried first with surgery as a last resort.

SOURCE: American Journal of Neuroradiology: Nomenclature and Classification of

Lumbar Disc Pathology

Dr. Fred states, " Don’t be confused by the terminology! The implication

is, that a herniation is worse than a bulge; or that if bulge or herniation is

not touching a nerve, that it will not be painful. These are common

misconceptions that are held by doctors, as well as lay-people! THE KEY ISSUE IS

THE ANNULAR TEAR!!

The annular tear is, in and of itself, painful. And, it is the character of the

annular tear, (i.e., how big it is, and whether it is longitudinal or radial),

that determines whether the disc will bulge or herniate. The annular tear is

analogous to a hole in a tire. The size of the hole determines if the tire will

have a blow-out, or a slow-leak. "

Dr. continues, " The truth is, in the vast majority of cases of low back

pain, the bulge or herniation does NOT touch the nerve. And, when the bulge or

herniation does touch the nerve, it causes LEG pain, not BACK pain! As our

knowledge of low back pain has grown over the years, we have had to adjust our

thinking. This misconception, however, seems to persist, despite what we have

learned. "

SOURCE: Dr. Fred Patients with disc herniations in the cervical,

thoracic, or lumbar spine can present with neck pain, back pain, arm pain, leg

pain or any combination of the above. As explained above, the pain may be due to

the bugling or herniated disc pressing on either the spinal cord or a nerve root

and/or due to the damage to the disc itself. The disc has its own nerve called

the sinuvertebral nerve which monitors mechanical and chemical stimuli and whose

purpose is to perceive pain. SOURCE: Dr. Fred

If the herniation occurs in the neck, it may cause pain in the neck and/or

radiate into the shoulder, arm, and hand; if it occurs in the back, the pain

produced may be in the back and/or radiate down into the hip, groin, leg, and

foot. Sometimes, patients with disc herniations can present with weakness in an

extremity or signs of spinal cord compression such as difficulty with gait,

incoordination, or loss of bladder/bowel control. If symptoms include

incoordination or loss of bladder/bowel control, immediate medical attention is

necessary.

In many cases, people have disc herniations, but do not have pain. Conversely,

the pain that a patient has may not be completely caused by the disc causing

pressure on the nerve. It may come from the inflammation that occurs at the

joints in the spine as well as tightness or spasm of the surrounding muscles.

All these issues must be addressed when treating this problem.

Bennie