If you’re like most people you have heard of disc bulges,
herniations, degeneration, etc. You may even have a friend or family member who
has dealt with chronic pain associated with one or more of these conditions.
Traditionally, disc bulges have been considered a “normal” process of aging
that most of us will experience in the course of time, but never in a kid,
right? There are certain perspectives underlying this assumption that I’d like
to address while presenting you with some new research that reveals that this
problem is not necessarily age-related.
Ok, so let’s break this issue down into bite-sized pieces.
What is an
intervertebral disc?
An intervertebral disc (IVD) is the collection of tissues
that exists between each of your vertebrae (with the exception of the upper
cervical spine – top neck bones). The IVD is made up of a gel-like internal
substance (nucleus pulposus) that is confined by an outer ring of fibrous
tissue (annulus fibrosus).
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| Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/ |
What does an IVD do?
Generally, it is understood that IVDs provide a base of
support and help to guide motion in the different regions of the spine, i.e.
the low back. For these reasons, they have been compared to a “shock absorber”
in a car.
What is disc bulge?
A disc bulge or herniation occurs when the weight of the
body is abnormally distributed. The increased pressure on the front of the disc
causes the gel-like substance inside to protrude or “bulge” against the outer
fibers. It’s sort of like pressing on one side of a ketchup packet, the ketchup
inside shifts away from the pressure. If these forces are sufficient, the outer
fibrous tissues can tear. These injuries are known as disc herniations and are
extremely painful. Even minor bulges can cause low back pain, leg and buttock
pain, and shooting pains down the leg, but are often asymptomatic. Magnetic
Resonance Imaging (MRI) technology is the gold standard for detecting disc
abnormalities.
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| Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/ |
What causes disc
bulges?
In a nutshell, disc bulges (and degeneration for that
matter) are caused by abnormal structural shifts in the spine. Interestingly
enough, the area where the shift occurs is not always the area where the disc
injury occurs. Atlas Displacement Complex, for example, is a primary shift that
can occur in the upper cervical spine (upper neck). When the weight of the head
becomes displaced away from its center of gravity, the large muscles of the low
and mid back kick in to stabilize a progressively unstable situation. The
resulting muscle spasm impacts the structural loading of the discs in the low
back. This abnormal pressure over time leads to decreased disc health and often
injury.
Who gets disc bulges?
This is where things get interesting. Traditionally this
condition has been considered a normal process of aging. Often folks who seek
medical help for disc related injuries are middle aged and older, and so we’ve
associated these injuries to “wear and tear” over time. However, new research
is shedding light on a previously unknown population who may have early onset
disc problems.
A recent study conducted at the Dwight D. Eisenhower Army
Medical Center looked at the prevalence of incidental MRI findings in the
pediatric population, in this case ages 8-18. Retrospectively, 99 pediatric MRI
studies were analyzed. Of the 99, over 30% (31 of 99) showed abnormal findings,
with the most being in the lumbar spine (low back region). Of the low back
findings in this pediatric population, the largest percentage of abnormal
findings were disc bulges! By the numbers:
- 99 Pediatric MRI studies analyzed
- 31 showed incidental findings
- 14% of these findings were in patients with NO symptoms
- 51.6% of the significant findings were disc bulges (protrusions)
What’s the takeaway?
This study is the first of its kind with the pediatric
population. The findings suggest that structural abnormalities with the spinal
bones and discs can occur early in life which may progress over time. Back and
leg pain in the pediatric population should be taken seriously considering
these findings. A study recently published in the Journal of Neurosurgery
suggests that a significant percentage of disc bulges spontaneously resorb, but
this study was not necessarily specific to the pediatric population.
Does it make sense that the structural integrity of the
spine is important, especially in the pediatric population? Minor shifts that
occur during this time in life can have significant consequences if not
addressed. In my office, I check kids for the presence of Atlas Displacement
Complex for this very reason. Early detection leads to more normal spinal
development and ensures that neurological function is optimal as kids grow.