Disc herniations and protrusions

Last update: 25/09/2018, Dr. Miguel B. Royo Salvador, Medical Board number 10389. Neurosurgeon y Neurologist.
 

The cord traction force increases the intradiscal vertebral pressure and therefore the application of lower than normal strains or loads can provoke a premature rupture of the fibrous annulus of the intervertebral discs. For this reason disc protrusions and herniations are more common in the Filum Disease/Neuro-Cranio-Vertebral Syndrome (FD/NCV.S).

Generally, the treatment indicated for patients suffering from the FD/NCV.S and associated disc herniations, is to apply only the Sectioning of the Filum Terminale (SFT) and to observe the clinical evolution of the protruded-herniated disc, with the exception of cases with an existing clinical picture of intense pain or with an evident neurological deficit related with the disc herniation, then the exeresis will be indicated for the same surgical session. Once the SFT has been applied, and the herniated disc is not operated during same surgical session and the symptoms associated with the herniated disc persist or worsen, then the surgical removal of the herniated disc is indicated. This attitude is based on the positive evolution of the condition that has been observed on several occasions when the exeresis was not realized due to the patients’ personal reasons, and where after the disc protrusion’s – herniation’s clinical picture and expression in the imagery improved following the release of the spinal cord traction.

In the case of lumbar and thoracic herniated discs, the most widely used technique is the discectomy via semi-hemi-laminectomy for the lumbar disc herniation and the trans-arterectomy for the thoracic disc herniation. In the case of the cervical disc herniations, a discectomy via anterior approach with the placement of a graft or intersomatic cage is applied.

For more information on the different types of herniated discs, please see:

Cervical herniated disc
Thoracic herniated disc
Lumbar herniated disc