What is a herniated disc?
Explained simply: between vertebrae are intervertebral discs, and in the center of the intervertebral discs there’s the gelatinous nucleus pulposus; surrounding the nucleus pulposus is a fibrous ring that contains an abundance of collagen. Intervertebral discs are made up of both of these types of tissue: nucleous pulposus and the fibrous ring. A herniated disc is when cracks appear in the fibrous ring and the nucleus pulposus is in a state of escaping outward.
There are roughly 2 types of herniated.
“Protrusions”: In this type, there are few cracks in the fibrous ring, and nucleous pulposus does not escape. However, nucleus pulposus does transfer backwards and place pressure on part of the nerve.
“Extrusions”: In this type, cracks appear in the fibrous ring due to intervertebral disc damage, and nucleus pulposus breaks through the fibrous ring and places pressure directly on the nerve.
What is the cause of herniated discs?
The main cause is deterioration of the intervertebral discs brought on by genetic factors and the burdens of aging and everyday life. The nucleus pulposus inside the intervertebral disc is essentially full of water, but cracks in the fibrous ring that come along with the burdens of aging and everyday life cause leakage of nucleus pulposus and loss of water content, which makes the disc become thin and collapse. In particular, lifting heavy things in daily life or playing intense sports causes damage to intervertebral discs. The intervertebral disc will appear dark on an X-ray or MRI, and its collapsed condition can be confirmed.
What is the cause of pain from herniated discs?
It was previously considered a mystery if there was no pain even when a disc was severely herniated or, vice versa, when serious pain came from a mildly herniated disc, but recently we’ve come to understand that, as a result of protruding nucleus pulposus causing inflammation, that inflammation spreads to nearby nerves and leads to the appearance of pain. Also, it has been established that the inflammation from protruding nucleus pulposus may disappear naturally within a fixed period (a few months). Metaphorically speaking, like an open fire, if it is given new fuel, it will burn furiously, but if some time passes, it will be the same as a fire that burns out. And cinders will remain after the fuel has burned up. With herniation, if it is naturally assimilated after the inflammation, it may remain like those cinders. The cinders-like remaining herniation can look severe in an image examination, but there are no symptoms because it is post-inflammation.
The pain from a herniated disc is not physical pressure on the nerves from escaped nucleus pulposus, the cause is inflammation due to fresh nucleus pulposus escaping.
This means, in other words, that people whose pain has continued for several months constantly have new nucleus pulposus continuing to leak out. On the other hand, it means that people whose pain has improved are experiencing a situation in which leakage of nucleus pulposus has stopped. This is extremely important. Surgery removes leaked nucleus pulposus and makes inflammation go away, but since it cannot close cracks in the fibrous ring, nucleus pulposus will continue to leak, which is the reason for the high recurrence rate (around 30%).
Surgery cannot treat the root cause of intervertebral disc problems.
How is our treatment effective for herniated discs?
At our clinic, we perform repair and regeneration treatment for intervertebral discs that have aged and had cracks appear in the fibrous ring. We also perform PIDD, PODD, and PLDD treatment if the intervertebral disc has not aged and herniation is not protruding or extruding. However, when cracks have appeared in the intervertebral disc, it will eventually lose water content, and it is also thought that it will gradually narrow, so we recommend DST. Because DST(Discseel™) repairs tears in the fibrous ring that are the root cause of herniated discs, it is also effective for herniation that will not improve with surgery or that has recurred after surgery. Furthermore, if the nucleus pulposus continues to leak, the intervertebral disc will collapse, and the patient’s condition will ultimately be complicated by spinal stenosis. But preventing leakage of nucleus pulposus returns the intervertebral disc’s cushion function to its resilient state and inhibits the progress of spinal stenosis.
Repair and regeneration of the intervertebral disc is done with DST(Discseel™) treatment.
This is an illustration of an intervertebral disc that was repaired and regenerated with DST(Discseel™) treatment.
DST(Discseel™) is a treatment that can return collapsed intervertebral discs or discs that have lost water content and aged to their original, youthful state by repairing damage and aging and by regenerating the disc.
However, in cases of overly severe herniation, we may suggest first having surgery for the purpose of suppressing inflammation and then, after surgery, undergoing our clinic’s intervertebral disc treatment to prevent recurrence and maintain disc function.
Also, even in cases when an X-ray or MRI leads us to believe an intervertebral disc is normal, cracks may actually have appeared in the disc, and the nucleus pulposus may be leaking out little by little, factoring into pain. This may be diagnosed as low back pain of indeterminate cause. Our clinic’s DST(Discseel™) treatment uses contrast radiography to check whether there are cracks, so we perform reliable testing and diagnosis for patients whose low back pain has been assumed to have an indeterminate cause, and we can treat those patients.