4 mm disc herniation

There are many types of bulging or herniated discs. Central disc protrusion is one such type which affects the spinal cord and may potentially result in problems with nervous system, such as muscle weakness and radiating pain. The difference between a central disc protrusion and other standard bulging or herniated disc is that in central disc protrusion, the disc herniates or expands posteriorly or backwards into the middle of the spinal canal where the spinal nerve roots and spinal cord is present; whereas, in other disc herniation, the disc expands to either sides or forwards.

In central disc protrusion, if there is compression of any of the nerve roots, then it produces serious symptoms in the patient.

4 mm disc herniation

There are various causes for central disc protrusion, some which can be avoided and some which are unavoidable, such as injuries or traumas. Some of the common causes of central disc protrusion 2 are:. This leads to gradual squeezing of the spinal discs. The spinal discs are responsible for supporting the spinal vertebrae, cushioning them and acting as a shock absorber by allowing them to move or bend without impacting or compressing each other.

4 mm disc herniation

As mentioned before, compression of the nerve root due to central disc protrusion produces symptoms such as:. Treatment for central disc protrusion is required if the patient is experiencing debilitating symptoms, such as chronic pain and decreased mobility due to nerve compression from the herniated disc. Over-the counter pain medications are prescribed to relieve pain associated with central disc protrusion and some mild stretching exercises are recommended to relieve the compression on the nerve.

This type of conservative approach is effective in many patients suffering from central disc protrusion; however, it often takes many months before any type of relief is achieved. In some patients with central disc protrusion, it may be necessary to remove the entire disc and replace it with bone grafts and artificial disc in a surgery which is known as stabilization surgery.

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We follow a strict editorial policy and we have a zero-tolerance policy regarding any level of plagiarism. Our articles are resourced from reputable online pages. This article may contains scientific references. The numbers in the parentheses 1, 2, 3 are clickable links to peer-reviewed scientific papers.A foraminal herniated disc may also be known by several other terminologies, including a foraminal disc bulge or foraminal disc protrusion.

However, in the case of foraminal bulges, the disc blocks off some or all of the neuroforaminal opening, through which the spinal nerves exit at the affected level. This can occasionally cause a pinched nerve to occur, when considerable force is enacted against the neurological structure. This dialog will concentrate on discussing how foraminal herniations can affect nerve tissue and why so many are misdiagnosed as the actual source of back or neck pain.

The neuroforamen is a space on either side of the vertebrae through which nerve roots pass out of the central canal at every spinal level. There are left and right foramen at each level and nerve roots exit on both sides of the vertebral column.

Neuroforamen can be partially or completely blocked off due to many reasons, including spinal misalignment issues, spinal curvature issues, osteoarthritic changes and disc bulges. Pinched nerves are diagnosed far more often than they actually occur in the spine.

In many cases, the disc may well block much of the neuroforaminal space, but there is still plenty of room for the nerve to exit without suffering any compression at all.


Instead, the foraminal space would need to be virtually sealed and the bulge would need to actually compress the nerve fibers to elicit a symptomatic expression.

I always suggest clinical correlation with a neurologist for any suspected nerve compression syndrome, since often, the symptoms will not match the expectations for the diagnostic theory. In fact, in most cases, the symptoms will prove far too wide ranging for a single level compressive neuropathy condition to enact. Remember that even large herniations do not necessarily cause any pain or other related symptoms.

L5 S1 Disc Protrusion—Causes and Treatment of Back Pain Caused by a Slipped/Herniated Disc

Treatment options for pinched nerves are often incredibly unenlightened. Assuming that the disc is actually pinching the nerve, how can such common conservative care practices as physical therapy or drugs cure it? Strangely, many patients seem to do better with the passage of time alone, compared to any specific conservative care approach. In the case of true objective weakness or numbness and associated muscular dysfunction, the chances for an actual compressive neuropathy rise. However, this is a rule with possible exceptions.

Remember to consider all possible explanations for your symptoms, particularly if they do not correlate precisely to the clinical expectations of the diagnosis. This site uses cookies for best performance.

Continuing to use this site will imply acceptance of our privacy policy. Ok Privacy Policy.Not a big fan of reading? Note: I strongly suggest that you visit the Disc Anatomy Page before diving into to this section of the website, for I am going to assume that you know a little bit about the general anatomy of the lumbar spine.

Furthermore, since I will commonly use sagittal and axial MRI images as teaching tools, you might want to visit the MRI Page as well in order to get a handle on that subject. It's not nearly as comprehensive as this page, but it will give you a good understanding of lumbar disc herniations.

Foraminal Herniated Disc

Watch it here: Lumbar Disc Herniations. In this first section, I'm going to try not to go to deep and just hit the major topics of disc herniation; it's a good place to start for the general public. However, if you are a doctor or medical, chiropractic, or physical therapy student, you should definitely read through the entire page, which will give you a very thorough and up-to-date understanding of this common cause of patient morbidity. A disc herniation, which can also be called a protrusion, extrusion, prolapse, rupture, "slipped disc," or "bulge", is a somtimes-painful condition of the spine that occurs when the material from the center of the disc nucleus pulposus escapes through a tear in the posterior portion of the disc annulus fibrosus and then "focally" pokes out, often compressing the adjacent lumbar nerve root in the process.

Note the posterior displacement moving of the left traversing nerve root. Although disc herniations can be completely asymptomatic not a source of pain[25] they can also produce debilitating lower back pain, with or without a burning, numbing, tingling, electric-like pain in the lower limb, which is called leg pain, radiating lower extremity pain, radicular pain the medically correct termor sciatica the common term.

It is extremely important to understand that the low-back pain associated with the disc herniation comes from the annular tear that spawned the disc herniation, and the physical compression of the nerve root by the herniation, which causes an inflammatory process within the nerve root, is responsible for the sciatica.

To confuse things further, a nerve-root-compressive disc herniation can sometimes cause only low back pain or only radicular pain. Typically, however, the patient has a mixture of back pain and sciatica with the latter being the major component. The very first thing important to understand is that the word "herniation" is a parent category that has three children categories below it, Which include 1 disc protrusion a.

We will talk more explicitly about each one of these here. Disc herniations are also described by their location as visualized on axial from underneath imaging. Specifically, if we use the disc as a clock-reference 6 o'clock would be dead-center posteriora central disc herniation would be exactly at the 6 o'clock position; a paracentral disc herniation figure 1.

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Here is a popular picture that I use in my lumbar differential diagnosis II class. Disc Herniation Zones. Figure 1. Can you see the left, broad-based paracentral disc extrusion, which is about 6 mm in size? If not, click here. The arrows will be pointing out the herniation.

Although foraminal and far lateral disc herniations are not seen as often as central and paracentral herniations are, when they do occur, they are often trouble, for they don't typically respond well to conservative or even operative care. In fact, it is so large that it invades the neural foramen as well. Can you see it? Furthermore, if a disc fragment moves into the far lateral position it is sometimes missed on MRI.

And if it is not seen on the MRI, then it may be missed during discectomy, for the surgeon will probably not be looking at it. This is especially true if the surgeon is using one of the endoscopic techniques which significantly lessens his or her field of vision. Although you would think that the larger the disc herniation, the more severe the symptoms, this does not appear to be true. Specifically, we learned from Karppinen et al. Magnetic resonance imaging MRI findings that demonstrate a focal or asymmetric outpouching of the posterior or posterolateral disc margin especially at L4 or L5 will strengthen the diagnosis of symptomatic disc herniation.Sometimes, being able to spot the differences in something is not only elusive to lay people, but to professionals as well.

This is the case with abnormalities in the disc, the cushion between the bones of the back, called the vertebrae. Being able to identify disc abnormalities is important because they can be painful. While doctors can easily identify a large or obvious abnormality of the disc, being able to define more subtle abnormalities can be difficult.

This difficulty led several spine related professional medical societies, the American Society of Neuroradiology, the American Society of Spine Radiology and the North American Spine Society to develop recommendations for how to name certain conditions of the disc. The first set of recommendations was published in Since first published, these recommendations have been adopted by major orthopedic, neurosurgical, radiologic and rehabilitation organizations in the United States.

Firstly, one must be able to define what a normal disc is.

4 mm disc herniation

Ina normal disc is described as one that has a normal shape and does not have evidence of degeneration [2]. The recommendations further write that the normal disc is maintained wholly within the boundaries of the disc space, and defines what those boundaries are see Figure 1. Therefore a normal disc is not only normally-shaped, but also does not extend beyond its usual boundaries and does not have evidence of degeneration.

Once we can define normal, we can move on to what abnormal is. One of the most commonly-discussed abnormalities are disc herniations. Disc herniations can be further subdivided into protrusions and extrusions.

In a protrusion the herniated disc material possesses a sizable connection to the disc space Fig 2b. In an extrusion a large amount of disc material has extended beyond the disc space, connected only by a thin stalk Figure 3. Importantly, these are descriptions of disc-shape and do not match-up with pain or severity levels.

Herniated Disc - Patient Education

However, disc herniations can certainly cause back or leg pain. Disc herniations can compress nerves traveling into the leg, leading to nerve pain, numbness or muscle weakness.

Even if a disc herniation is not compressing a nerve, they can cause pain by generating a strong inflammatory reaction.The rubbery disks that lie between the vertebrae in your spine consist of a soft center nucleus surrounded by a tougher exterior annulus. A herniated disk occurs when a portion of the nucleus pushes through a crack in the annulus. Symptoms may occur if the herniation compresses a nerve.

A herniated disk refers to a problem with one of the rubbery cushions disks that sit between the individual bones vertebrae that stack to make your spine. A spinal disk has a soft, jellylike center nucleus encased in a tougher, rubbery exterior annulus.

Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the nucleus pushes out through a tear in the annulus. A herniated disk, which can occur in any part of the spine, can irritate a nearby nerve.

4 mm disc herniation

Depending on where the herniated disk is, it can result in pain, numbness or weakness in an arm or leg. Many people have no symptoms from a herniated disk. Surgery is usually not necessary to relieve the problem. Most herniated disks occur in the lower back, although they can also occur in the neck. Signs and symptoms depend on where the disk is situated and whether the disk is pressing on a nerve. They usually affect one side of the body. You can have a herniated disk without symptoms.

You might not know you have it unless it shows up on a spinal image. Seek medical attention if your neck or back pain travels down your arm or leg, or if you also have numbness, tingling or weakness. Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your disks become less flexible and more prone to tearing or rupturing with even a minor strain or twist. Most people can't pinpoint the cause of their herniated disk.

Sometimes, using your back muscles instead of your leg and thigh muscles to lift heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back is the cause. Just above your waist, your spinal cord ends. What continues through the spinal canal is a group of long nerve roots that resemble a horse's tail cauda equina.

Rarely, disk herniation can compress the entire spinal canal, including all the nerves of the cauda equina. Rarely, emergency surgery might be required to avoid permanent weakness or paralysis. Herniated disk care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version.

This content does not have an Arabic version. Overview Herniated disk Open pop-up dialog box Close. Herniated disk The rubbery disks that lie between the vertebrae in your spine consist of a soft center nucleus surrounded by a tougher exterior annulus. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter.Last Updated on March 28, by Martin Kielema. A herniated disc in your lower back is a well-known cause of lower back and leg pain. Remember that a herniated disc is only a problem when you suffer from radiating pain in your lower leg.

A herniated disc rarely causes only back pain. Luckily, most of these herniated discs are treatable without surgery. You have to do the right things. It makes it easier to understand the cause and treatment of your herniated disc. Unfortunately, this is sometimes necessary. For fast pain relief, you can wear a back brace to reduce pressure on your back, the disc and the nerve. It will help you to do the exercises you need to do to recover. Common herniated disc myths What is a herniated disc?

What causes a herniated disc? What are the symptoms of a herniated disc? Herniated disc treatment with three exercises Herniated disc exercises and activities to avoid Herniated disc surgery treatment.

I will tell you more about this later in this post. A herniated disc is a common MRI finding, but it is only relevant if you also feel radiating pain in your lower leg. If this is not the case, then the MRI finding very likely is not the cause of your back pain. Your lower back consists of 5 vertebrae. We call them lumbar 1 Between these vertebrae lies a discus or intervertebral disc.

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Due to different reasons, sometimes the annulus fibrosus weakens. When this happens, the nucleus pulposus starts to push the annulus fibrosis into the vertebral canal. When this happens, we speak of a bulging disc or disc protrusion. It is a pre-stage of a herniated disc. It results in a herniated disc. Now it enters the intervertebral foramen. These are the holes you can see in the picture. It results in compression of the nerve leaving the back on that level. The nerve runs through the intervertebral foramen.

It can also cause an inflammatory reaction. The inflammatory response happens because the nucleus pulposus never comes in contact with other parts of your body and is considered an intruder. The most common levels for a herniated disc are the L4-L5 and L5-S1 levels.

These levels receive the most pressure. At that age the disc no longer contains water. In a study done inthey analyzed over people without back pain.This type of herniation, like all other varieties, describes a condition in which the nucleus pulposus bulges or ruptures through the outer annulus fibrosus.

This educational essay focuses on explaining broad based intervertebral bulges and extrusions in the spinal anatomy. Sometimes a broad based herniation is represented on a circular map, in which case, the herniated portion is 90 to degrees of the total In many cases, the diagnostic term diffuse is substituted for broad based, but many care providers also use the term diffuse to mean general widespread or symmetrical bulging, as well.

The terminology used here is really quite irrelevant to patients, but these names often provide some degree of confusion on MRI and CT scan reports, so it is always a good idea to understand what they mean, at least in a very basic sense.

Broad based bulging discs are not any inherently worse than focal protrusions. Most broad based disc protrusions are not symptomatic or harmful in any way, although some may enact pain and possible related symptoms if they affect a neurological structure.

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These herniations seldom provide any cause for alarm, although they often act as back pain scapegoats. This is simply a space on the sides of the central canal. In some circumstances, lateral herniations may cause foraminal stenosis, which is defined as a narrowing of the space through which the spinal nerve roots pass.

Many diffuse herniations are found in diagnostic imaging studies, regardless of whether the patient has back pain or not. I always advise patients to learn all the facts about herniated discs before seeking any type of treatment and also getting at least 2 to 3 different opinions from a variety of care providers, including an orthopedist and a neurologist. This site uses cookies for best performance.

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