Extrusion is one of the stages in the development of an 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 of 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, this statement is not entirely true. After all, extrusion is, rather, the initial stage of the formation of a herniated disc. What is observed in such a disease?
Surely many workers in the industry are familiar with this term. Indeed, in production, the extrusion method is a process for obtaining materials from a polymer, in which the melt is squeezed out through a special hole. In this case, some analogies can be drawn.
In medical terminology, extrusion is a condition in which the fibrous ring of the disc ruptures, and prolapse of the nucleus pulposus is observed. At the same time, the latter goes out by 3-4 millimeters (it hangs down likea drop of water) and irritates the nerve roots.
Stages of formation of intervertebral hernia
In order to understand what extrusion is and what its role in the formation of an intervertebral hernia, you should consider the whole process.
Hernial protrusion is formed in three stages. To begin with, the so-called prolapse occurs, in which the substance of the intervertebral disc falls out of the functional segment, without breaking the fibrous ring. Due to the lack of water and nutrients, the mobility of the nucleus pulposus is significantly reduced.
In the future, the second stage is observed, which in modern medicine is called protrusion. In this case, the intervertebral disc is displaced by 3-4 millimeters (sometimes up to 15 mm) beyond the vertebrae.
Extrusion is the third stage of forming the protrusion. At this stage, there is a rupture of the fibrous ring and the exit of the substance of the nucleus beyond the vertebra. In most cases, strong compression of the nerve roots is not observed, since the nucleus is held back 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, as it often causes compression of the sciatic nerve.
Extrusion and its varieties
In modern medicine, there are several classification systems for various spinal diseases. For example, extrusion is quite often divided into types depending on which directionnucleus pulposus falls out.
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 also a dorsal disc extrusion, which is accompanied by 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 disc extrusion. With this form of the disease, the substance of the nucleus does not protrude outward, but into the spinal column, which is extremely dangerous, since there is always the possibility of squeezing the spinal cord. There is also a posterolateral form of the disease, in which protrusions are observed at the back and sides.
Sometimes a doctor makes a diagnosis of "subligamentary disc extrusion". What it is? In this case, the name does not indicate the direction of the protrusion of the substance, but the stage of development of the disease. If at the initial stages the cartilaginous tissue of the nucleus is displaced, but still held due to the posterior longitudinal ligament, then in this case, damage to the ligament and the formation of subligamentous 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.
But there are some other reasons as well. 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 hernia.
Of course, the list of causes includes injuries to muscles and ligaments. 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 susceptible to injury and take on the main burden when moving.
What are the symptoms of the disease?
In fact, disc extrusion is not always accompanied by any obvious and noticeable symptoms. Quite often, the disease proceeds hidden. Pain and other signs appear only if the nucleus that has gone 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.
When there is a problem in the cervical region, there is pain in the shoulders. Often she gives to the elbows, forearms and fingers. Extrusion of the thoracic disc may be accompanied by disruption of some internal organs, as well as pain in the chest.
The most characteristic picture is observed in the defeat of the lumbar. As a rule, patients complain of pain in the hip or leg, as well as numbness or tingling in the lower extremities, toes. Extrusion of the sacrum canaccompanied by pain in the coccyx, pelvis and genitals.
Modern diagnostic methods
Of course, first you need to see a doctor. Indications for further examination are the patient's history, the 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 when examining the spinal column).
As a rule, magnetic resonance or computed tomography is prescribed to begin with, which makes it possible to confirm the presence of a 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?
Certainly, disc extrusion can be treated conservatively in most cases, 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 the weight, as this will eliminate pressure on the spine and other joints.
Physiotherapy is also mandatory. The patient must regularly engage in special exercises that will help strengthen the muscular corset, which, again, will reduce tension in the spine.
As for drugs, in some cases it is hardly possible to do without them. With a strong pain syndrome, appropriate means are prescribed. In the presence of inflammation, patients usually take nonsteroidal drugs. But with severe inflammation and intense pain, doctors may recommend steroids that are injected directly into the epidural space of the spinal cord.
Surgical therapies
If the extrusion exceeds 12 mm, outpatient treatment is rarely prescribed, as 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 manipulations are performed 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. After all, as the disease progresses, the nucleus pulposus will come out more, squeezing the roots, thereby increasing pain and worsening the quality of life.
On the other hand, the lack of timely therapy is fraught with the development of an intervertebral hernia. And if conservative treatment is possible with extrusion, then a hernia in almost every case requires surgical intervention.
