Degenerative disc diseases: bulging, protrusion, hernia

Disk degeneration is a natural ageing process.  Despite the fact that the symptoms are not always present, over time everyone experiences degeneration of intervertebral discs with different levels of severity.  The severity and nature of intervertebral disc degeneration varies significantly. 

What is Degenerative Disc Disease?

Degenerative Disc Disease is one of the most common causes of neck and back pain.  Diagnosis of Degenerative Disc Disease is a signal for many patients, because it constantly progresses and is considered as a severe disease.  Many people understand the term “degenerative” as a disease, which progresses with age.  Nevertheless, this term describes the symptoms, mainly occurring of disk degeneration over time.  

What is an intervertebral disc?

Intervertebral discs are cartilage tissue located between the vertebrae and provide the elasticity of our spine.  Discs create spaces between the vertebrae and allow spinal cord to move.  As the age increases, these spaces are narrowed, and the spine becomes shorter and less elastic.  Disk consist an outer fibrous ring (annulus fibrosis) that surrounds an inner gel-like center, the nucleus pulposus.  At the same time, discs support the natural curve of the spine. 

How does Disc Degeneration occur?

The structure of the discs changes with age.  The water content decreases and the size reduces.  Even in healthy people, disc herniation, a decrease in turgor, deformation, overflow (drying out) of the pulpous nucleus, may occur with age and narrowing of the intervertebral foramen occurs due to a decrease in size.  Past traumas (of which people may or not be aware of), accelerate the disc degeneration process.  There are other causes which speed up the process, such as occupational trauma, postural kyphosis, and genetic factors.  

What would happen if disk degeneration process starts?

As long as there is degeneration (erosion, abrasion, fragility) in the intervertebral disc, osteoarthritis (calcification) in the spine is being developed. 

Osteoarthritis, osteophyte in the bones is a growth of bone tissue, which is causing pain by compressing the soft tissues and nerves. Osteoarthritis often affects the joints that are subject to stress.  Degeneration of disk is accelerated with the onset of osteoarthritis. Load on the front and back joints increases. Front joints are disks, back joints are facet joints.

Risk for herniation is higher in degenerative disk. Disk degeneration along with osteoarthritis results in narrowing of spinal canal. Narrowed spinal canal compresses nerves and CSF in cervical and thoracic parts, and nerves in lumbar part.

What are the signs of degenerative disc disease? 

Symptoms of degenerative disc disease may vary depending on the localization that is affected. With degenerative disease of the cervical area, neck pain, occipital rigidity, in degenerative disease of thoracic area, back pain and in degenerative disease of lumbar area lumbar pain may occur. Sometimes there may be pain that is spreading towards upper or lower extremities due to squeezed nerve. The pain may even get as far as hands and feet. In addition, there may be symptoms such as numbness, rigor, tingling, burning, and loss of strength. Some positions and movements can increase or decrease the pain. Symptoms of dizziness, psychological disturbance, and impaired vision can be present during cervical degenerative disk problem. Unattended (late) cervical degenerative disc disease may eventually lead to cervical mellitus.

In which part of the spine, degenerative disc disease may appear?

Degenerative disc disease can be found in all segments of the spine. However, cervical and lumbar degenerative disk diseases are more common. Thoracic disease is also common. Sometimes it is observed all across the spine. 

What is bulging intervertebral disc?

Discs that are located in between the vertebras provide movement. Disc bulging - is when weakened and fragile disc is swollen and dislocated from its usual place. Usually it is a slow and long process.

What is intervertebral disc protrusion and hernia?

Intervertebral disc protrusion is very common during degenerative disc diseases. The tension of the outer part (annulus fibrosis) in the damaged and weakened disk is a result of displacement of the pulpous nucleus. In herniated disc, the pelvic nucleus is shifting from the central part through a rupture in the fibrous ring. The difference between a protrusion and a hernia is the rupture in the fibrous ring during the last one.

Signs and symptoms of protrusion and hernia

Symptoms may be different depending on the area in which hernia and protrusion are located. For example, if disc protrusion and hernia are in cervical disk, then symptoms such as neck pain, pains that spread to arms, numbness and rigor, signs of weakness may appear. If disc protrusion and hernia are in lumbar disks, then symptoms as back pain, pains that spread to the legs, numbness and rigor, and weakness can be observed.

How degenerative disc disease is diagnosed?

Early changes are better detected by computer tomography (CT) and magnetic resonance imaging (MRI) examinations. Often detailed patient’s history and good physical examination is enough. Direct x-ray imaging is sufficient for diagnosis in many patients. Magnetic resonance imaging (MRI) examinations and computer tomography (CT) may additionally be required depending on disease course (progression). EMG (Electromyography) examination for detecting nerve suppression and scintigraphy examination for tumor and pathological infections are more informative. 

Treatment of degenerative disc disease

It is essential to start the treatment early and on time. Medical treatment, physical activity, occupational alignment, weight decrease are very important. Regular physical education is absolutely necessary. Physiotherapy procedures can help. Need for surgical intervention is very rare.

Degenerative disc disease; treating disk bulging, protrusions and hernia with PROLOTHERAPY

Prolotherapy is a non-surgical therapy which is used efficiently in the treatment of degenerative disc disease. Prolotherapy is based on the self-renewal and recovery of the body-proliferation. Injection of hypertonic sugar solution in the damaged area of the spine (joints, ligaments and tissues), accelerates the healing process by restoring damaged tissues. As a result, the joints and ligaments heal and strengthen. Prolotherapy is a type of treatment which is an alternative to surgery. It’s a non surgical treatment of degenerative disc disease, disc bulging, protrusion, and hernia of the spine. Prolotherapy is even ideal treatment for the patients, who have undergone spinal surgery, but still have pains after the surgery.

The duration of treatment is 3-6 sessions depending on the severity of the disease. Each session lasts 25-40 minutes.

After the procedure, the patient can immediately return to normal life. Despite the fact that, prolotherapy has been successfully used in the United States since 1940 and Turkey since 2008, in our country this method was first used by me in 2014.

Types of prolotherapy
 - With hypertonic solution
 - With platelets-rich plasma
 - With stem cells

Prolotherapy is not only applied to spine related diseases, but is also used in patients with knee, hip joint arthrosis, twists, muscle aches, fibromyalgia, carpal tunnel syndrome, Kubital syndrome, tennis elbow, pubis simphis pain and other diseases.

Do not make a decision on undergoing surgery without trying prolotherapy treatment first!