Lateral Disc Protrusion

A lateral disc protrusion may cause back pain or sciatica when the material pressing out of the disc pushes into the nerve riit where it exits the spine.

A lateral disc protrusion is a condition where the outer wall of a spinal disc becomes weak enough that it bulges outwards, or tears along its outer envelope. This condition affects patients when the disc wall or ejected disc material presses into the spinal nerves or spinal ligaments. Symptoms that the lateral disc protrusion has affected the spinal nerves include:
  • Acute back pain
  • Chronic back pain
  • Sciatica (pain related to the irritation or compression of the sciatic nerve)
  • Numbness and tingling in the legs or arms
  • Muscular de-conditioning (prolonged pressure on the nerve may cause muscle weakness or atrophy)
  • Radiculopathy and Referred Pain. Referred pain is pain that travels to other areas of the body. Radiculopathy is pain that radiates away from the source of the injury, and along the path of the nerve.
Directionality is an important factor that may affect whether or not a patient experiences pain or disability related to a lateral disc protrusion. Many back experts think that patients experience lower back pain and sciatica when the spinal nerves are impacted by degenerative changes in the intervertebral discs. If the material being expelled from the disc does not directly contact the spinal nerve roots, the patient will be less likely to experience pain and disability. If the bulging or herniating part of the disc is directed sideways, where the nerve exits the spine, the patient will be more likely to be affected.

Diagnosis and treatment: There are several tests that may be performed on patients to visually see the soft tissues of the spine, such as CT Scans and MRIs. While X-Rays may show the health and shape of the vertebral bones, MRIs actually allow doctors the ability to see the discs, spinal nerves, and spinal nerve roots. Doctors may use MRIs to locate the disc material and rate how severely the nerve is being affected, based on what they see on the films. Based on what the radiologist and the physician who ordered the films sees, they may decide to treat the problem with conservative treatments or more aggressive treatments, such as nerve root blocks or back surgery. Let's take a look at how nerve root blocks may provide doctors with more diagnostic information about the patient's condition.

Selective Nerve Root Block (SNRB): a selective nerve root block is a pain management injection that is designed to stop pain caused by compression of the nerve root. The injection contains lidocaine, which is a numbing agent, and a steroid, which acts as an anti-inflammatory. The injection is delivered directly into the sheath around the nerve root. Before the injection, the doctors may have the hypothesis that the source of the patient's pain is at the site where the MRI indicates nerve room compression. But until doctors perform some form of treatment on the nerve root, they may never know for sure. Following the injection, the patient will say whether or not he experiences back pain or leg pain relief. If this treatment provides the patient with immediate relief, that may give doctors the conformation they need.

The SNRB includes the guidance of the injection needle to the foramen of the spine where the nerve exits it. The nerve root is the section of the nerve where it exits the side of the spine through the foramen. Fluoroscopy (a live X-ray) is used to carefully guide the needle into position. The lidocaine is the component of the injection substance that will provide immediate pain relief if that nerve root is the cause of the patient's pain. The steroid is the chemical that will reduce inflammation around the nerve root. If successful, this inflammatory may provide up to several months of pain relief.

The Selective Nerve Root Block procedure should be limited to no more than three times per year. Abusive use of this treatment more than three times a year could lead to destruction of the tissues.

SNRB injections are not associated with complications such as a wet tap (spinal headache), unlike epidural steroid injections. A spinal headache may occur during epidural injections when the needle punctures the dural sac, causing a leak of cerebral spinal fluid (CSF). Complications related to CSF leaks include photosensitivity (light sensitivity), headache, double vision, decreased hearing, and tinnitus (ringing in the ear).