Will a Lumbar Disc Extrusion Heal by Itself?

will a lumbar disc extrusion heal itself

Will a Lumbar Disc Extrusion Heal by Itself?

Well, the answers are yes, but mostly no.

Lumbar disc extrusion is a condition that occurs when the soft inner core of the intervertebral disc, known as the nucleus pulposus, escapes through a tear or fissure in the tough outer layer of the disc called the annulus fibrosus. This escape can lead to compression of nearby spinal nerves, causing pain, numbness, tingling, and weakness in the lower back and legs. Understanding the process of lumbar disc extrusion and its implications for healing is crucial for effective management of this condition.

Understanding a Lumbar Disc Extrusion

The intervertebral discs act as cushions between the vertebrae of the spine, providing stability, flexibility, and shock absorption. Each disc consists of a gel-like nucleus pulposus surrounded by a fibrous ring of the annulus fibrosus. The annulus fibrosus is composed of layers of collagen fibers arranged in a crisscross pattern, providing strength and structure to the disc.

In lumbar disc extrusion, the integrity of the annulus fibrosus is compromised, allowing the nucleus pulposus to protrude beyond its normal boundaries. This can occur due to various factors such as trauma, degenerative changes, or repetitive stress on the spine. When the nucleus pulposus herniates through the annulus fibrosus, it can exert pressure on the spinal nerves, leading to symptoms of radiculopathy or sciatica.

The body’s natural response to lumbar disc extrusion involves an inflammatory reaction aimed at removing the herniated material and repairing the damaged tissue. Macrophages and other immune cells are recruited to the site of injury to phagocytose (engulf and digest) the extruded nucleus pulposus fragments. Over time, the body gradually resorbs the herniated material through a process called phagocytosis, reducing the size of the disc herniation.

However, while the body is capable of absorbing the herniated material to some extent, the underlying structural issue of annulus fibrosus tears or fissures often persists. These annular defects serve as pathways for the nucleus pulposus to extrude again, even after it has been resorbed. The presence of annulus fibrosus fissures compromises the integrity of the disc and predisposes it to further extrusions.

This explains why lumbar disc extrusion can be a recurrent problem, with individuals experiencing multiple episodes of disc herniation over time. Despite the body’s attempts at healing by absorbing the herniated material, the underlying annulus fibrosus defects remain, leaving the disc vulnerable to future extrusions.

Disc Extrusion Treatment and Intervention

Surgical intervention, such as a discectomy, may be necessary in cases where conservative treatments fail to alleviate symptoms or when there is severe nerve compression. During a discectomy, the surgeon removes the herniated portion of the disc to relieve pressure on the spinal nerves. While this can provide immediate relief from symptoms, it does not address the underlying issue of annulus fibrosus integrity.

Even after a successful surgical discectomy, the risk of disc re-extrusion remains, primarily due to the persistence of annulus fibrosus fissures. The surgical removal of the herniated material does not repair or reinforce the annulus fibrosus, leaving it susceptible to further tears or weakening. As a result, individuals who have undergone discectomy may still experience recurrence of symptoms if the annulus fibrosus fails to adequately contain the nucleus pulposus.

Discseel® is a new, non-surgical procedure that seals the fissures resulting in restoring disc annulus integrity. Discseel® address this common lumbar disc problem at its origin and can spare individuals to prospect multiple recurrent spine surgical procedures. Find out more about Discseel® at RegenerativeSpineAndJoint.com. 

Lumbar disc extrusion involves the escape of the nucleus pulposus through tears or fissures in the annulus fibrosus of the intervertebral disc. While the body’s natural healing response involves the absorption of the herniated material, the underlying annulus fibrosus defects often persist, predisposing the disc to recurrent extrusions. Surgical intervention may be necessary in severe cases, but even after successful surgery, the risk of disc re-extrusion remains due to the persistent annulus fibrosus fissures. Discseel® is an ideal non-surgical intervention to resolve the disc annulus fissures, which can not heal spontaneously.

In order for a disc protrusion, disc bulge, disc herniation or a disc extrusion to be present, there must be disc annulus fissures present to cause weakening of the disc wall.  When disc annulus fissures extend long enough to travel through the entire thickness of the disc annulus, then certain molecules can leak out of the center of the disc (nucleus pulposus), through the disc annulus fissures and into the epidural space, which is where spinal nerves are located. These leaking molecules trigger a series of chemical reactions that result in inflammation, which is irritating to nerve tissue. This inflammatory process can cause nerve pain symptoms in the corresponding leg even without any MRI evidence of a compressed “pinched” nerve.

Disc fissures will never repair on their own because the disc lacks a blood supply sufficient for healing.  For the same lack of blood supply reason, disc fissures cannot be surgically sewn successfully.  If left untreated, disc fissures predictably progress and eventually reach the outermost portion of the disc annulus, causing them to leak over time. The center of the disc (nucleus pulposus) eventually loses enough of its fluid content causing the disc to decrease in height and eventually collapse. This process is called Degenerative Disc Disease.  On MRI these discs appear dark and flat compared to discs that are not degenerating.

Learn About Discseel®

The only way to solve this problem is to seal the disc fissures, ideally before the disc starts to collapse.  Because this cannot be accomplished surgically, an ideal non-surgical alternative is Discseel®.  This new non-surgical procedure injects the healing protein fibrin into each tear to immediately seal the disc.  Over the following months, the fibrin promotes disc tissue growth, sealing and healing previously torn discs.  There are several other injection procedures that attempt to treat disc pain (stem cells, PRP, etc.), but they are all limited by the fact that they cannot immediately seal the disc tears and these products end up leaking back out of the disc, which minimizes their benefit.  Learn more about Discseel® at RegenerativeSpineAndJoint.com and find out how your low back disc protrusions and disc bulges can be successfully treated non-surgically.

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I’m Boris Terebuh MD, Ohio’s first and most experienced Discseel® provider. I am also the Founder & Medical Director of the Regenerative Spine & Joint Center