Many terms are used to describe problems with vertebral discs—it can be confusing! Dr. Todd H. Lanman is a renowned expert in spine surgery and Artificial Disc Replacement (ADR), with over 30 years of experience in the field of spinal neurosurgery. As the founder of the Advanced Disc Replacement Spinal Restoration Center (ADR Spine), Dr. Lanman has made significant contributions to the advancement of spinal care, particularly in motion preservation techniques and artificial disc replacement. In this article, Dr. Lanman will set the record straight on the disc diseases and answer once and for all the difference between prolapsed disc vs herniated disc.
Prolapsed disc vs herniated disc: Is there a Difference?
No. A prolapsed disc and a herniated disc are the same thing. A slipped disc and a ruptured disc are other terms for a prolapsed disc or herniated disc—they all mean the same thing. A herniated disc, prolapsed disc, slipped disc, or ruptured disc is when there is a tear in the outer layer of the disc that allows the inner material of the disc to protrude. This can cause irritation or compression of nearby nerves, resulting in pain, numbness, or weakness.
Healthy Intervertebral Disc
A healthy intervertebral disc is a complex structure composed of two main parts:
- Nucleus Pulposus: This is the soft, gel-like center of the disc. It’s primarily composed of water, proteoglycans, and collagen fibers. The nucleus pulposus acts as a shock absorber, distributing pressure evenly across the disc.
- Annulus Fibrosus: This is the tough, fibrous outer ring that surrounds and contains the nucleus pulposus. It is made up of concentric layers of collagen fibers, providing strength and flexibility to the disc.
A healthy disc maintains its shape and position between the vertebrae, allowing for smooth movement of the spine while providing cushioning and support.
Common Types of Disc Damage
Bulging Disc
A bulging disc occurs when the entire disc extends beyond its normal boundaries in the spinal column. The annulus fibrosus remains intact, but it weakens and allows the disc to bulge outward. This condition is often age-related and can be asymptomatic, but may cause pain if it compresses nearby nerves.
Herniated Disc
A herniated disc, also known as a prolapsed or ruptured disc, occurs when there’s a tear in the annulus fibrosus, allowing some of the nucleus pulposus to protrude through the tear. This protrusion can irritate or compress nearby nerves, leading to pain, numbness, or weakness in the affected area.
Sequestrated Disc
A sequestrated disc is an advanced form of disc herniation. In this case, a portion of the nucleus pulposus not only herniates through the annulus fibrosus but also separates from the main disc, becoming a free fragment in the spinal canal. This free fragment can migrate up or down the spinal canal, potentially causing severe nerve compression and neurological symptoms.
Other Types of Diseased Discs
- Desiccated Disc: This condition involves the loss of water content in the disc, leading to decreased height and flexibility. It’s a common part of the aging process but can also occur due to injury or genetic factors.
- Annular Tear: This refers to a tear in the annulus fibrosus without herniation of the nucleus pulposus. It can cause localized back pain and may predispose the disc to future herniation.
- Degenerative Disc Disease: This is not a specific disease but a term used to describe the normal changes in spinal discs as we age. It can involve disc desiccation, loss of disc height, and the development of bone spurs.
- Schmorl’s Nodes: These are protrusions of the cartilage of the intervertebral disc through the vertebral body endplate and into the adjacent vertebra. They’re often asymptomatic but can sometimes cause pain.
- Infected Disc (Discitis): This is an infection of the intervertebral disc space, often caused by bacteria. It can lead to severe back pain, fever, and in some cases, neurological deficits.
Prolapsed Disc: Key Details
What Is a Prolapsed Disc?
A prolapsed disc, also known as a herniated or slipped disc, is a condition affecting the intervertebral discs of the spine. These discs act as cushions between the vertebrae, providing shock absorption and facilitating spinal movement. In a prolapsed disc, the soft, gel-like center (nucleus pulposus) pushes through a tear in the tough outer layer (annulus fibrosus) of the disc. This protrusion can irritate or compress nearby nerves, leading to various symptoms. The condition most commonly occurs in the lower back (lumbar spine) but can also affect the neck (cervical spine) or, less frequently, the upper back (thoracic spine).
Symptoms of a Prolapsed Disc
The symptoms of a prolapsed disc can vary widely depending on the location and severity of the protrusion. In many cases, patients experience localized pain in the affected area of the spine. When the prolapsed disc compresses or irritates nearby nerve roots, it can cause radicular pain that radiates along the path of the affected nerve. For instance, a lumbar disc prolapse may lead to sciatica, characterized by pain radiating down the leg. Other common symptoms include numbness, tingling sensations, and muscle weakness in the affected limb. In severe cases, a prolapsed disc in the lumbar region can cause cauda equina syndrome, a medical emergency characterized by loss of bladder or bowel control. It’s important to note that some individuals with disc prolapses may be asymptomatic, especially if the prolapse doesn’t impinge on neural structures.
How a Prolapsed Disc Occurs
The development of a prolapsed disc is often multifactorial. Age-related degeneration is a primary contributor, as discs naturally lose water content and become less flexible over time, making them more prone to tears. Repetitive stress on the spine, such as from heavy lifting or prolonged sitting in poor posture, can accelerate this process. Traumatic injuries, like those from car accidents or falls, can cause sudden disc prolapse. Genetic factors also play a role, with some individuals being more susceptible to disc degeneration. Lifestyle factors such as obesity, smoking, and lack of regular exercise can increase the risk of disc prolapse. The actual prolapse occurs when the internal pressure of the disc exceeds the strength of the annulus fibrosus, causing the nucleus pulposus to push through. This can happen gradually over time or suddenly with a particular movement or injury. Understanding these mechanisms is crucial for both prevention and treatment of prolapsed discs, allowing for targeted interventions and lifestyle modifications to mitigate risk and manage symptoms effectively.
Conservative Treatments for Prolapsed Disc
Conservative treatments are generally the preferred initial approach for managing prolapsed discs, as they are non-invasive, carry fewer risks, and can often provide significant relief without the need for surgery. Dr. Todd Lanman, with his extensive experience in spinal care, emphasizes the importance of exhausting conservative options before considering surgical intervention. He can guide patients through a comprehensive treatment plan, tailoring approaches to individual needs and closely monitoring progress to ensure optimal outcomes.
Non-Surgical Approaches
Physical therapy is a cornerstone of conservative treatment for prolapsed discs. A skilled physical therapist can design a program that includes exercises to strengthen core muscles, improve flexibility, and correct posture, all of which can help alleviate pressure on the affected disc and reduce pain. Medications play a crucial role in managing symptoms, with nonsteroidal anti-inflammatory drugs (NSAIDs) often prescribed to reduce inflammation and pain. For more severe cases, short-term use of muscle relaxants or opioids may be considered under close medical supervision. Epidural steroid injections can provide targeted relief by delivering anti-inflammatory medication directly to the area surrounding the affected nerve roots.
Chiropractic care, when performed by a qualified practitioner, may offer relief for some patients by improving spinal alignment and reducing pressure on the prolapsed disc. Alternative therapies such as acupuncture, massage therapy, and yoga have shown promise in managing pain and improving overall function for some individuals. These approaches can complement traditional medical treatments and may be particularly beneficial for patients seeking holistic care options.
In addition to these common approaches, Dr. Lanman may recommend other conservative treatments. These could include the use of a lumbar support brace to provide stability and reduce strain on the lower back during daily activities. Lifestyle modifications, such as weight management and ergonomic adjustments in the workplace, can play a significant role in reducing stress on the spine. Some patients may benefit from transcutaneous electrical nerve stimulation (TENS) therapy, which uses low-voltage electrical currents to alleviate pain. Heat and cold therapy, applied alternately, can help manage pain and reduce inflammation. In some cases, Dr. Lanman might suggest a short period of rest followed by a gradual return to normal activities, as prolonged bed rest is generally not recommended for prolapsed disc management.
When Surgery Is Required
While conservative treatments are often effective, some patients may require surgical intervention if symptoms persist or worsen despite non-operative management. Dr. Lanman carefully evaluates each case to determine when surgery becomes necessary, considering factors such as the severity of symptoms, the impact on quality of life, and the presence of neurological deficits.
Surgical Options
Microdiscectomy is a common surgical procedure for treating herniated discs and, less frequently, prolapsed discs that have not responded to conservative care. This minimally invasive technique involves removing the portion of the disc that is compressing the nerve root. Dr. Lanman uses advanced microsurgical techniques to perform this procedure, which typically results in faster recovery times and less tissue damage compared to traditional open surgery.
Laminectomy is another surgical option that may be considered, particularly for cases where the prolapsed disc is causing spinal stenosis (narrowing of the spinal canal). This procedure involves removing a portion of the vertebral bone (lamina) to create more space for the nerves and relieve compression. In some cases, a laminectomy may be combined with a discectomy to address both the prolapsed disc and any associated spinal narrowing.
For patients with significant disc degeneration or instability, Dr. Lanman may recommend more advanced surgical techniques such as artificial disc replacement or spinal fusion. Artificial disc replacement involves removing the damaged disc and replacing it with an artificial implant, preserving motion at the affected spinal level. Spinal fusion, while less commonly used for simple disc prolapses, may be necessary in cases of severe instability or when other techniques have failed.
Dr. Lanman’s expertise in both traditional and cutting-edge surgical techniques allows him to offer personalized treatment plans that address each patient’s unique needs, always prioritizing the least invasive option that will provide effective relief.
Dr. Lanman’s Preference for Artificial Disc Replacement (ADR)
The primary reason Dr. Lanman favors ADR is its ability to maintain or restore natural spine movement. Unlike spinal fusion, which immobilizes the affected vertebrae, ADR allows patients to retain their spinal range of motion. This preservation of mobility is crucial for maintaining an active lifestyle and preventing additional stress on adjacent spinal segments. Furthermore, ADR typically results in faster recovery times compared to fusion surgery, enabling patients to return to their normal activities sooner.
What Is ADR?
Artificial Disc Replacement is a revolutionary approach to spine surgery that involves replacing damaged or degenerated intervertebral discs with artificial implants. These prosthetic discs are designed to mimic the function of natural discs, allowing for mobility of the spine.
The procedure involves removing the damaged disc and inserting an artificial disc in its place. This artificial disc acts as a joint, enabling the spine to bend, flex, and rotate as it would with a healthy natural disc. ADR can be performed in both the cervical (neck) and lumbar (lower back) regions of the spine.
Dr. Lanman has been at the forefront of ADR development and implementation. He has served as a principal investigator in numerous clinical trials for motion-preserving surgeries and artificial disc devices, contributing significantly to the advancement of this technology. His expertise in ADR has made him a sought-after surgeon for patients seeking to maintain their spinal mobility while addressing chronic pain and degenerative disc conditions.
The durability of artificial discs is a key factor in Dr. Lanman’s advocacy for ADR. These implants are designed to last, with many having a durability cycle of 70+ years. This longevity offers patients a long-term solution that can potentially eliminate the need for future surgeries.
Dr. Lanman’s commitment to ADR is further exemplified by his pioneering work in Restorative Motion Surgery, a technique that involves reversing previous spinal fusions and replacing them with artificial discs. This innovative approach has opened up new possibilities for patients who have undergone fusion surgery but are experiencing limitations in mobility or ongoing pain.
By championing ADR, Dr. Lanman continues to push the boundaries of spinal care, offering patients the opportunity to not only alleviate pain but also maintain or restore their natural spinal function and mobility.
Prevention of Prolapsed and Herniated Discs
Preventing prolapsed and herniated discs is crucial for maintaining long-term spinal health and overall well-being. By adopting certain daily habits, understanding proper ergonomics, engaging in targeted exercises, and maintaining a healthy diet, individuals can significantly reduce their risk of developing these painful conditions.
Building a Healthy Spine: Daily Habits to Prevent Disc Injuries
Incorporating practical daily habits into your routine can go a long way in maintaining spinal health and preventing disc injuries. Here are some key practices to consider:
- Maintain proper posture: Keep your spine aligned whether sitting, standing, or walking. When sitting, ensure your feet are flat on the floor, your knees are at a 90-degree angle, and your back is supported.
- Take regular breaks: If your job requires prolonged sitting or standing, take frequent breaks to move and stretch. Aim to change positions at least every 30 minutes.
- Practice proper lifting techniques: When lifting objects, bend at the knees and use your leg muscles rather than your back. Keep the object close to your body and avoid twisting while lifting.
- Stay hydrated: Proper hydration is essential for maintaining the health of your intervertebral discs, which rely on water for cushioning and shock absorption.
- Get adequate sleep: Ensure you’re getting enough quality sleep on a supportive mattress to allow your spine to rest and recover.
Importance of Ergonomics: How to Protect Your Spine at Work and Home
Proper ergonomics play a crucial role in preventing spinal injuries, especially in our increasingly sedentary lifestyles. Here are some key ergonomic considerations:
- Workstation setup: Adjust your computer monitor to eye level, position your keyboard and mouse at elbow height, and use a chair that supports the natural curve of your spine.
- Use ergonomic tools: Consider using ergonomic accessories such as a standing desk, lumbar support cushion, or ergonomic mouse to reduce strain on your spine.
- Home ergonomics: Apply ergonomic principles at home as well, such as using proper posture while watching TV or reading, and ensuring your bed provides adequate support for your spine.
- Avoid prolonged smartphone use: Limit the time spent looking down at your phone to prevent “text neck” syndrome, which can strain the cervical spine.
Exercise and Stretching: Essential Movements to Support Spine Health
Regular exercise and stretching are vital for maintaining a healthy spine and preventing disc injuries. Here are some recommended exercises:
- Core strengthening: Exercises like planks, bird dogs, and bridges help strengthen the muscles that support your spine.
- Low-impact cardiovascular exercises: Activities such as walking, swimming, or cycling can improve overall fitness without putting excessive stress on your spine.
- Pilates: This practice can improve flexibility, core strength, and body awareness, all of which contribute to better spine health.
- Stretching routines: Regular stretching of the back, hamstrings, and hip flexors can help maintain flexibility and reduce the risk of injury.
- Avoid high-impact activities: Exercises that involve heavy lifting, twisting, or sudden impacts should be approached with caution or avoided if you are at risk for disc injuries.
Diet and Bone Health: How Nutrition Plays a Role in Spine Longevity
Proper nutrition is essential for maintaining healthy bones and discs. Here’s how diet impacts spine health:
- Calcium and Vitamin D: These nutrients are crucial for bone health. Include dairy products, leafy greens, and fortified foods in your diet. Sunlight exposure also helps with Vitamin D synthesis.
- Magnesium: This mineral enhances calcium absorption and helps convert Vitamin D into its active form. Include spinach, nuts, seeds, and whole grains in your diet.
- Protein: Adequate protein intake is necessary for tissue growth and repair, including the muscles that support your spine.
- Anti-inflammatory foods: Incorporate foods rich in omega-3 fatty acids and antioxidants, such as fatty fish, berries, and leafy greens, to help reduce inflammation in the body.
- Hydration: Staying well-hydrated is crucial for maintaining the health of your intervertebral discs.
- Weight management: Maintaining a healthy weight reduces stress on your spine and decreases the risk of disc herniation.
Additional Considerations for Spine Health
- Stress management: Chronic stress can lead to muscle tension and poor posture. Incorporate stress-reduction techniques such as meditation or deep breathing exercises into your daily routine.
- Quit smoking: Smoking can deprive spinal tissues of nutrients and oxygen, increasing the risk of disc degeneration.
- Regular check-ups: Schedule regular check-ups with a spine specialist or chiropractor to address any potential issues early on.
- Proper footwear: Wear supportive shoes that promote good posture and reduce strain on your back, especially if you spend a lot of time on your feet.
By incorporating these preventive measures into your daily life, you can significantly reduce your risk of developing prolapsed or herniated discs and maintain a healthy, pain-free spine for years to come.
Dr. Lanman’s Final Thoughts on Prolapsed vs Herniated Discs
As a spinal neurosurgeon with over 30 years of experience, I’d like to share my perspective on the key takeaways from this comprehensive article on prolapsed and herniated discs.
First and foremost, the terms “prolapsed disc” and “herniated disc” are essentially interchangeable. Both refer to a condition where the inner material of an intervertebral disc protrudes through a tear in the outer layer. This can lead to various symptoms, including localized pain, radicular pain, numbness, and in severe cases, neurological deficits.
In my practice, I advocate for exhausting non-surgical options before considering surgical intervention. These conservative approaches, including physical therapy, medications, and epidural injections, can often provide significant relief and should be pursued diligently. However, when conservative treatments fail to provide adequate relief, surgical intervention may become necessary. As a surgeon who has been at the forefront of spinal care innovation, I’m particularly excited about the advancements in Artificial Disc Replacement (ADR) technology. ADR offers a revolutionary approach to treating degenerative disc disease by preserving spinal motion, which is a significant advantage over traditional spinal fusion procedures.
Looking towards the future of spinal surgery, I believe we’re on the cusp of some truly groundbreaking innovations. The field of regenerative medicine, including stem cell therapies and tissue engineering, holds immense promise for treating spinal disorders. These approaches may one day allow us to regenerate damaged disc tissue, potentially eliminating the need for surgical intervention in some cases. Additionally, I anticipate further advancements in artificial disc technology. We’re likely to see newer designs that offer even greater durability and more closely mimic the function of natural discs. The integration of advanced materials and biomechanics will lead to implants that provide better long-term outcomes for patients.
Another area of innovation is the increasing use of robotics and navigation systems in spine surgery. These technologies allow for unprecedented precision in surgical procedures, potentially leading to better outcomes and faster recovery times for patients.
My work in Restorative Motion Surgery, which involves reversing previous spinal fusions and replacing them with artificial discs, represents another frontier in spinal care. As we continue to refine these techniques, we’re opening up new possibilities for patients who have undergone fusion surgery but are experiencing limitations in mobility or ongoing pain.
In conclusion, while conditions like prolapsed and herniated discs can be challenging, the future of spinal care is bright. With ongoing advancements in both conservative and surgical treatments, we’re moving towards a future where we can not only alleviate pain but also restore and maintain natural spinal function. As a surgeon and researcher, I’m committed to staying at the forefront of these innovations, always striving to provide the best possible outcomes for my patients.
FAQs About Prolapsed and Herniated Discs
What is the most common cause of a prolapsed disc?
The most common cause is age-related degeneration combined with repetitive stress on the spine. As we age, our discs naturally lose water content and become less flexible, making them more prone to tears. This process can be accelerated by factors such as poor posture, repetitive lifting, or prolonged sitting.
When should you seek surgical treatment for a prolapsed disc?
Surgical treatment should be considered when conservative treatments have failed to provide adequate relief after 6-12 weeks, or if there are progressive neurological deficits such as severe pain, numbness, or weakness. Immediate surgical intervention may be necessary in cases of cauda equina syndrome, which is a medical emergency.
Can a prolapsed disc heal without surgery?
Yes, many prolapsed discs can heal without surgery. The body has a natural ability to reabsorb the herniated disc material over time. With proper conservative treatment, including physical therapy, pain management, and lifestyle modifications, many patients experience significant improvement without surgical intervention.
Is Artificial Disc Replacement safe for long-term use?
Yes, Artificial Disc Replacement (ADR) has proven to be safe and effective for long-term use. Clinical studies have shown excellent outcomes with ADR, with many implants designed to last 70+ years. As a pioneer in this field, I’ve seen firsthand how ADR can provide long-lasting pain relief while maintaining spinal mobility, often with better long-term outcomes compared to traditional spinal fusion. Because, as you may know by now, I have also had 11 spine surgeries myself.
