The Body Can Heal Injured or Herniated Disc

Written By Dr. Glenn Corkins, DC, PhD on October 18, 2018

The Body Can Heal Injured Disc and Joints

By  Glenn Corkins, DC, PhD

                To understand the injury that can occur to the lumbar disc of the spine resulting from an auto crash, we need  to introduce a little anatomy.   The MRI looks at the lumbar spine from the side, called a sagittal view; and the MRI looks at a horizontally cross section called an axial view.   By examining these two views at each lumbar level and comparing the changes in normal anatomy we can begin to see the injury.  

             Figure 1:   Axial View of lumbar vertebra to show the disc.

Figure 1:   Disc Lesion Nomenclature

Let’s consider the anatomy from a horizontal view, i.e., the axial MRI views.  Injury to a disc can occur as a bulge, protrusion, extrusion, or sequestration see figure 1.   The difference between the extrusion and protrusion is the size of stalk.   As the stalk narrows a protrusion becomes an extrusion.  When the stalk is eliminated the disc is sequestered.  When looking at MRI reports, the radiologist refers to injury to different regions around the disc.  A normal disc is simple divided axially which produces a pie with four large slices each designated as being 25% of the circular disc, Figure 1.  As a disc gets injured it presents in the MRI as distorted anatomy and moves into different regions of the disc environment.  A bulge in the disc is a herniation.  It is focal if it lies within a 25% pie slice.  If it is broad and occupies two slices (180°) it is referred to a  broad based herniation.  And sometimes the disc just expands in a 360° fashion and is called a circumferential bulge see figure 1.   

 

Figure 2:  Axial View of Lumbar shows disc

 

Figure 2:  Axial Disc Nomenclature

Figure 2 is an axial view that shows examples of the zones or environment the injured focal herniated disc finds itself within a joint or vertebral level.   The central zone is important because this is the area where the spinal cord lives.  The foraminal area is important because this is where the spinal nerves exit the cord and provide innervation to other body structures.  The sub articular zone is also known as the lateral recess.  The foraminal zone is the hole the nerve exits as shown by the green nerve in the diagram.   The foraminal zone is important because there is not much room in the hole where the nerve exits.  Pinching off the canal or the IVF can have serious consequences on nerve function and the organ the nerve is servicing.   A central canal zone impingement by a disc protrusion or extrusion can affect the spinal cord.

                               The environment the disc finds itself is also used to identify an injury.   The following figure (3) shows some common joint anatomical locations.   Notice, the disc itself is composed of an inner portion called the nucleus pulposus and is surrounded on all sides by long filaments of fibers called the annulus fibrosus.  It is a common MRI finding that the annulus is injured by tearing allowing the nucleus pulposus to protrude or extrude into the surrounding tissue; hence creating a “herniation.”   And depending where the break in the annulus occurs the bulging disc can contact and interfere with the function of some of the surrounding tissue, e.g., a nerve originating in the spinal cord and traveling through the IVF (intervertebral foramen) to secure innervation to a body organ.  The black hole with the green dots is the location of the spinal cord which transverse up and down the spine.   At this level of the spine a cross section of the spine shows the cauda equina, or several individual nerve bundles at the lower end of the spinal cord, which service the pelvis and lower extremity.  The ligamental flavum is the ligamentous tissue that surrounds the back or posterior portion of the spinal canal.   MRI can show injury to this ligament.   

                                                                                                                                                                                         

Figure 3:   Axial view normal Joint Anatomy

 Figure 3: Axial View NormalJoint

The disc can be injured in a way the herniation or bulge covers a larger area than a focal herniation, as shown in figure 4.   A diffuse bulging is noted to occur over all of the disc in 360 degrees  or it may occur over 180 degrees of the disc.  A diffuse bulging can be symmetrical or asymmetrical.   In either case, the disc can cut off or impinge on an exiting nerve causing nerve impingement.   Injury to a lumbar disc can have serious consequences because the injury may affect a  nerve or the spinal cord directly.

                                       

      

In almost all cases, event that damaged lumbar discs, one or more, also causes a change the overall movement pattern of the lumbar spine.  Changes in dynamic movement pattern in turn changes the way the disc and surrounding tissue get nourished, i.e., imbibition.  A herniated  disc is alive and can heal if the tissue gets proper nourishment.   Since the body is in a perpetual state of reconstitution, a spinal joint is rebuild every 12-14 months.   So a complete rebuild is in progress but the body needs the proper nourishment to fix any injured disc.  To supply nourishment to the injured area requires treatment to restore normal spinal movement.    Chiropractors are skilled musculoskeletal doctors trained in restoring normal movement within the spine and would be the doctors of choice for treatment of injured discs no matter how the injury presents.

                                                                                                                                                                                           

 Figure 5:    Axial view showing Bulging Discs

Figure 4:  Axial View Shows Bulging Discs

                It is important to remember that an MRI image is a captured image in time.   If allowed to go untreated the progressive deterioration of a disc is known to follow the development of joint:   loss of disc space; endplate sclerosis; and osteophytes    It doesn’t matter what type of disc injury, i.e., diffuse bulge; focal herniation or protrusion,  extrusion or even damaged that involves a sequestered fragment.  This degenerative process occurs over time progressing with development of degeneration of the injured area observable by MRI.  However, without further injury to the area and treatment that restores spinal nourishment, the injured disc or herniation may regressively withdraw and heal.   The healing of disc herniations is well documented as a result of conservative care especially chiropractic care.

Looking at a lumbar spine from the side, i.e., the sagittal view, the MRI can be very helpful in identifying lumbar disc injuries.    Figure 5 shows a normal lumbar spine from the side.   There are a number of anatomical sites to note.

 

Notice the lumbar discs are even with the faces of the anterior vertebrae.  The hole the spinal nerves exit (IVF) is formed by the junction of two vertebrae.  The L-5 nerve root exits between L5 and S1 vertebrae; the L4 nerve root exits between L4-L5, and so on.  The disc height between the vertebrae are all about the same height.Lumbar spine Cropped

               

 

                                                                                                                                     

The MRI takes a picture of a thin slice through the central portion of the spine in the “plane of the paper.”   From this view the health of the spine can be accessed as well as the health of the lumbar discs.  Injury shows up as herniations that affect the central canal or spinal cord.  Figure 6 shows three MRIs of a lumbar spine.   The three separate MRI views of the lumbar spine are taken at different times.    The initial view shows a major herniation at the level of L3-L4 that is impinging on the thecal sac (spinal cord).  In this case, with conservative care and time, the body healed and repaired the L3-L4 herniation as is noted with successive MRIs one and eight months later.

Figure 5:  Normal Lumbar Spine

herniated disc healing1

Figure 6:  Progressive Healing of a Herniated Disc

 


Posted In: Back Pain Chiropractic Auto Injury Spinal Treatment