Degenerative disc disease and other kinds of abnormalities can be common findings on spine imaging. Many patients read their reports and are worried or concerned those findings of disc displacements such as “bulge,” “protrusion,” “herniation,” and “extrusion” might mean the worst. Instead, most of these findings are usually asymptomatic. Any diagnostic test must be interpreted in the total context of the patient. The specialists at Columbia Pain Management are experts at interpreting spinal diagnostics and findings on radiological studies to plan treatment and set the stage for spinal healing.
The first thing to remember is that the natural history of disc displacement is largely resolution but by different mechanisms. Extruded discs heal differently compared to non-extruded discs.
Extruded discs migrate inferiorly (usually) and thin out as they go while the supply of nutrients from the annulus and nucleus pulposis have been disrupted. Extruded discs are usually larger than contained disc prolapse and the Japanese longitudinal studies reflect the relatively more rapid volumetric resolution of the larger disc herniations compared to smaller disc herniations, with a 50% resolution in size in 4 months and 11 months respectively.
Non-extruded discs (herniations, protrusions, and bulges) continue to have nutrient and oxygen supply from the nucleus pulposis, and create a thickened fragment of physiologically active disc material lodged through the 11 lamellar layers of the posterior annulus fibrosis. Therefore, these require a longer time to resolve via the metalloproteinase mechanisms.
Radicular pain is caused by inflammation primarily from the inflammatory disc content contacting the nerve which partially degrades the myelin. Acute compression of the nerve does not lead to radicular pain, but instead leads to numbness and weakness. This was demonstrated in awake neurosurgery during which time the nerve was cross-clamped. There was no pain, but there was instant numbness and weakness.
On the other hand, chronic compression may lead to vaso nervorum venous compression and venous engorgement with subsequent intraneural edema, and more of an achy, rather than sharp or lancinating pain. Of course a synovitis adjacent to an exiting nerve may lead to neural inflammation and simultaneously with compression.
For extruded discs, it is not clear to me that physiotherapy or chiropractic or traction or central disc decompression would make any difference given the anatomy. There may be some benefit from these treatments to contained disc herniations. The real kicker is how to avoid reinjury of the same area since the collagen cross bridges require so much greater time in the disc than anywhere else. Re-herniation in the absence of repair is estimated between 30 and 70%. Frequently the annulus has not sufficiently healed even though the pain has resolved, thereby giving patients a false sense of security they may go back to the same types of activities that may have caused the problem in the first place.
In the absence of neurological impairment, one way to heal these damaged or degenerated discs is to use platelet lysate injections around the spinal nerve, disc, and into the epidural space. Platelet lysate contains growth factors from platelets and plasma that can facilitate healing and injury repair. These precise injections are performed with fluoroscopic guidance in order to put the highest concentration of growth factors nearest to the damaged or injured disc and spinal nerve.
The specialists at Columbia Pain Management use Regenexx’s proprietary method for making advanced platelet lysate from your own blood. In lieu of a conventional epidural steroid injection, a platelet lysate injection may provide patients with the same or more pain relief while also facilitating tissue repair and regeneration. Call us 541-386-9500 to learn if a platelet lysate injection may be able to help speed recovery from your injured or damaged spinal disc problem.