When discs cause “trouble”

Disc prolapse. The most common cause of lumbar spine pain.

The intervertebral discs are essential for the functionality of the human spine. They help to maintain its stability, and above all, they act as shock absorbers between the vertebrae in every movement. Their constant activity and workload also make them one of the most common causes of back pain.

Fig. The disc consists of a solid outer ring (anulus fibrosus) and a jelly-like core (nucleus pulposus)

Discs are shock absorbers

The spine consists of a total of 33 vertebrae with a flexible intervertebral disc of durable fibrous cartilage inserted between each of them. Although the discs are rigid, they are also elastic - they have the ability to compress under pressure and change shape. Their main task is to cushion the impact between the vertebrae, whether during movement - walking, running, jumping or any other strain on the spine. This ability, combined with the natural curvature of the spine, is a prerequisite for a flexible yet stable spine. There are no nerves in the disc (which is why we cannot “feel” a healthy disc), nor blood vessels to nourish it. However, it contains a relatively large amount of water, which has a major influence on its elasticity. The more water in the disc, the better it can withstand the load pressure and act as a “cushion”. If water is missing from the disc, the height of the disc changes, as does its shock absorption capacity. Consequently, the flexibility of the spine deteriorates.

The spine and discs age with us

Back pain arises from numerous causes. Disc prolapse is one of the ‘structural’ causes, where direct damage to the body’s tissues occurs. Natural ageing of course contributes to the development of degenerative changes in the intervertebral discs, but it can be significantly accelerated by a lack of physical activity, frequent extended sitting, stereotypical activities or inappropriate strain during work or sports activities. The actual prolapse then occurs as one of the possible consequences of such degeneration, whether due to injury, excessive stress, acute strain, or even spontaneously.

Other possible manifestations of disc degeneration are disc dehydration, where the disc shrinks, often followed by inflammatory changes and ingrowth of previously absent nerves and blood vessels. Gradually, bone growths - osteophytes - may form, and spinal arthrosis and other degenerative diseases such as narrowing of the spinal canal (stenosis), spondylolisthesis - “vertebral displacement” and other painful conditions may develop.

How prolapse occurs and what manifestations it may have

A common problem is disc prolapse, technically referred to as protrusion or herniation, and sometimes commonly called a slipped or ruptured disc. When the solid outer layer of the disc is breached (due to trauma, impact or wear from age), the inner jelly-like part of the mass is pushed out. This can lead to compression of the spinal nerve root, which most often causes pain in some part of the lower limb. In lumbar discs, prolapse is most often seen between the L5-S1 and L4-L5 vertebrae.

There are several types of prolapse. During initial prolapse (protrusion), the disc core bulges, but does not break through the outer solid ring. This condition is sometimes referred to as a “bulging” disc. If the disc nucleus pushes through the outer rim via a rupture in the outer ring, extrusion occurs. The most conspicuous form of prolapse is sequestration, when part of the prolapsed core separates from the disc and “falls” into the spinal space as a sequestrum (fragment). All these cases can result in oppression or irritation of the nerve roots with the subsequent spreading of pain to the nerve root axons. In worse cases, there may be a reduction in sensitivity or even muscle strength and mobility of the limb. This may already be a sign of incipient permanent damage to the root.

In general, not every disc prolapse necessarily means pain, nor is all back pain caused by a prolapse. Many people live with a certain pathology or change on the disc, including prolapse, and do not experience any problems - they are asymptomatic. However, if the pain persists for a long time (more than 3 months), do not to hesitate to visit a specialist and start treatment, to ensure it does not develop into an adverse complicated condition.

Everybody wants a healthy and strong back, so it is also a good idea to think about how to prevent the development of spinal disorders and disc damage. Your own actions play an important role in maintaining or changing your lifestyle: strive for good posture, learn and use correct movement patterns, avoid pain-inducing mechanisms, exercise regularly and strengthen your core, watch your weight, follow a balanced and varied diet, and ideally limit smoking and alcohol. 

Minimally invasive and endoscopic procedures may be appropriate for some types of disc prolapse. Are discs the cause of your persistent problems? Has an MRI scan definitely identified a disk prolapse? Your current treatment does not bring relief? Find out if this type of treatment might help you. Take advantage of the recommendations from Advice.me.