spinal stenosis
To understand a paracentral disc herniation, one needs to know a little bit about the structure of a disc. There are two general structures associated with a disc, which includes the nucleus pulposus and the annulus fibrosus. The nucleus pulposus is in the center of the disc, which contains a gelatinous center that acts as a weight-bearing fluid along the vertical axis and acts as a pivot point to allow some movement around the trunk of your body. The annulus fibrosus forms a bag around the nucleus pulposus and is mostly made of multiple concentric layers of collagen (a protein). The annulus fibrosus functions to contain the gel of the nucleus pulposus under a wide range of pressures. Where the disc meets the spinal cord there is a thecal sac. This thecal sac is another form of tough connective tissue that surrounds the spinal cord. If you have a tear in the annulus fibrosus, the nucleus fluids may protrude and put pressure on the thecal sac. This is a common problem and may occur from improper lifting of heavy objects, accidental trauma and aging.
You will need to set up an appointment with your healthcare provider to determine if you have a paracentral herniated disc. Discus your family history and let your doctor know what kind of pain you are experiencing as well as severity. Your doctor will give a physical exam and possibly take X-rays to determine any structural abnormalities that may be present. One of the things doctors look for is to determine what pain you are experiencing. Are you experiencing a nerve pinch? In this case, the annulus fibrosus is torn and the fluid from the nucleus pulposus is causing the annulus to bulge, which in turn presses against nerves of the spinal cord. This is known as nerve root pain that is also known as sciatica when you have a lumbar herniated disc. On the other hand you may be experiencing disc pain also known as axial pain as there are no nerves involved.
Paracental herniated discs may generate a pinched nerve in the lower back. A pinched nerve in the lower back can compress the sciatic nerve causing sciatica. A herniated disc may also cause spinal stenosis (a narrowing of the spinal canal), which may pinch nerves at that level. Common symptoms associated with a pinched nerve include pain, numbness, tingling sensation (needles and pins) or weakness of muscles associated with that nerve bundle. The pain may radiate down your back, legs and buttocks. Quite often the doctor can identify the nerve involved based on what part of your back, leg and buttock that is affected. How does one treat a pinched nerve? Rest and cold compresses work well. Braces are sometimes used for a short time to limit movement around the pinched nerve to prevent further damage and allow for healing. There are a number of pain/anti-inflammatory medications that can be used for example ibuprofen that can reduce swelling and decrease pain. Your healthcare provider may need to prescribe something stronger for serious pain. Physical therapy (exercise) is also necessary for stretching and strengthening muscles to relieve pressure on the pinched nerve. If these therapies do not work for you, surgery may become necessary particularly if you develop loss of bowel or bladder control, as this is a sign of more serious nerve damage. It may be necessary to remove part of a disc to stop the nerve compression. If this is done then you may require a spinal fusion to stabilize the spine. These are unusual situations and in most cases, patients recover from pinched nerves with home therapies without long-term symptoms.
Axial pain is generally not related to a disease state and is the most common type of low back pain. A number of structures can cause axial or mechanical pain and is difficult to identify which structures are responsible. Axial pain gets worse with certain activities such as sitting for long periods of time, exercise (sports) and gets better with rest. This type of disc pain may become worse with the presence of a degenerated disc, joint problems, muscle damage, ligament or tendon damage. Axial pain problems are generally localized and don't radiate down your legs, feet or buttocks. It is generally not necessary to identify the particular structures involved, as this will resolve itself in a short amount of time. Treatment for axial back pain can be done at home. You will want to rest for a few days and make use of cold/hot compresses in alternating fashion. Physical therapy involving strengthening and stretching of the muscles is next when it is comfortable for you to do so. It is a good idea to take an over-the-counter pain reliever/anti-inflammatory as well. If you axial pain continues for more than 6 to 8 weeks, it is a good idea to see your healthcare provider again for additional testing to determine other therapies that will work for you. Generally, axial disc pain goes away within a few weeks with simple home treatment. The ideal situation is to avoid axial pain all together. A healthy lifestyle is paramount. Maintain a healthy weight, exercise (strengthen your back muscles and keep them in balance), eat properly and get plenty of rest.
On June 30, 2010, a research study was published in the Journal of Arthritis and Rheumatism revealing a possible role of the immune system and back pain associated with herniated discs. When the annulus tears/ruptures, the fluid in the center comes in contact with the blood system. This gelatinous fluid of the disc has never been exposed to the immune system (the internal part of the disc contains no blood vessels). Since the white blood cells have not seen this fluid before, they see it as foreign and attack it to get rid of it generating inflammation. This causes a local nerve root and other tissues to become inflamed, damaged and compressed. The molecule that activates the inflammatory reaction has been identified as interleukin-17 (IL-17), which is a chemical messenger molecule produced by a particular white blood cell. This particular subpopulation of white blood cells are known to be involved in autoimmune responses such as asthma and arthritis. If scientists can find a way to block the production of IL-17 by this particular subpopulation of cells, autoimmunity along the spinal column and hence inflammation can be brought to a halt. This should allow the herniated disc to go about normal healing without having to contend with chronic inflammation and pain. This will work for both acute and chronic inflammation and pain.
Depending on the symptoms of a paracentral herniated disc, there are a number of ways to deal with the situation. Most patients respond well to conservative treatments without the requirement of surgery. Make use of chiropractors, physical therapists, rest, hot/cold compresses and home exercise. Make sure to maintain a healthy lifestyle by eating properly to maintain a proper weight. Perhaps in the near future researchers will have a drug that will prevent excessive inflammation and pain that will allow for faster healing without discomfort with an IL-17 blocker.
Now that we know more about cellular pathways and the workings of the genome, medical advances are growing at an increasing rate. It's a good idea to keep yourself well informed by reading as many of the medical websites as you can. Make sure you bring this information to your next doctor's visit.
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