Written By: David J. Cicerchia, MD, Board certified Spine Surgeon Department of Orthopedics, Kent Hospital on August 29, 2024
Back pain is the second leading cause of visits to the doctor (behind upper respiratory tract infection). About 60% to 80% of people will suffer from low back pain in their lifetime. More than half of patients who seek treatment for low back pain recover in one week and 90% within 1-3 months. Healthcare costs regarding this diagnosis are $100 billion a year. Risk factors for developing low back pain and disc problems include:
- Smoking
- Obesity
- Vibration (truck drivers, machine operators, etc.)
- Job dissatisfaction
Lumbar Disc Anatomy:
The lumbar intervertebral disc is made up of two components. The outer layer is called the “annulus fibrosis.” It is made up of collagen fibers that are crosshatched in orientation like the fibers of a radial tire and provide strength and tension.
The second component is called the “nucleus pulposus.” This is contained within the annular fibers as it is the central core. This comprises a second type of collagen and is 90% water. It gives strength and compression and has a more gelatinous or “jellylike” consistency.
It is the nucleus pulposus that bulges protrudes, or herniates through the defects in the outer annulus that can cause issues.
Lumbar Disc Changes and Pathology:
With aging, there is a decrease in the water content of the disc, decreasing its material properties. This leads to degeneration which is a normal part of the human condition and aging process. It is this process that can lead to a disc that bulges, protrudes, herniates, or tears.
- Bulge - This is when the nucleus pulposus pushes on the outer annulus fibrosis as it shows signs of wear and tear, but the annulus remains intact. The annulus may have degeneration in tears, but if it is intact, it is considered a normal finding as we go through life.
- Protrusion – This is when the nucleus pulposus protrudes into the annulus but remains contiguous with the disc space. Again, this is a normal finding as we go through life.
Scientific studies have shown that disc bulges, protrusions, and tears on MRI are found in most people as we go through life and are completely asymptomatic. Asymptomatic people between the ages of 40 and 50 have bulges, protrusions, and tears on MRI in 55% of cases. From ages 50 to 60, MRIs have these findings 60% of the time. Over the age of 60, there is an 80% rate of MRIs that are read as having a disc bulge, protrusion or tear in asymptomatic individuals.
The bottom line is that often MRI reports describe an image using adjectives that may seem daunting but can be a normal finding in the healing condition. It should be a spine specialist surgeon who puts these findings in context and explains what they mean.
- Herniation – This is when the nucleus pulposus passes through the annulus, is no longer contiguous with the disc space, and compresses the spinal cord or nerves. This condition presents not only as back pain but more importantly, leg pain that worsens with sitting, coughing, and sneezing. It can improve with standing or lying down. The leg symptoms can present as pain, weakness, or numbness.
Lumbar Disc Herniation Treatment:
Only about 5% of people will become symptomatic. The majority will be resolved over time. 90% to 95% of cases improved without surgery and responded well to conservative treatment.
The L5-S1 disc is the most common level to be involved. MRI is needed only when symptoms persist for more than six weeks of conservative care including anti-inflammatories, activity restrictions, and physical therapy, or when there are progressive neurologic deficits.
The minority of patients whose symptoms persist may require cortisone injections or surgery. These decisions should be guided by your spinal surgeon.
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Disclaimer: While I am a doctor, I am not your doctor. The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.
