What are the types of intervertebral disc prolapse involving the lumbar vertebrae and their associated clinical symptoms?

From the Guidelines

Lumbar disc prolapse is categorized into four main types: disc bulge, protrusion, extrusion, and sequestration, with clinical symptoms including low back pain, sciatica, numbness, tingling, or weakness in the leg or foot, and positive straight leg raise tests due to nerve root compression, as reported in the most recent study 1. The types of disc prolapse involving lumbar vertebra are:

• Disc bulge: the disc extends beyond the vertebral margin but the annulus remains intact
• Protrusion: the nucleus displaces but remains contained by outer annulus fibers
• Extrusion: nuclear material breaks through all annular layers but remains connected to the disc
• Sequestration: a fragment completely separates from the disc Clinical symptoms of lumbar disc prolapse typically include:
• Low back pain that may radiate down one or both legs (sciatica)
• Numbness, tingling, or weakness in the leg or foot
• Positive straight leg raise tests due to nerve root compression
• Symptoms that worsen with activities that increase intradiscal pressure like sitting, bending, lifting, or coughing The most commonly affected levels are L4-L5 and L5-S1, with L5 nerve root compression causing weakness in foot/toe dorsiflexion and sensory changes over the dorsum of the foot, while S1 compression affects ankle plantar flexion and sensation on the lateral foot, as described in the study 1. Some key points to consider in the diagnosis and treatment of lumbar disc prolapse include:
• Imaging is usually not appropriate for the initial imaging of patients with acute low back pain with or without radiculopathy, no red flags, and no prior management, as stated in the study 1
• MRI lumbar spine without IV contrast is usually appropriate as the initial imaging of patients with subacute or chronic low back pain with or without radiculopathy and who are candidates for surgery or intervention with persistent or progressive symptoms during or following 6 weeks of optimal medical management, as recommended in the study 1
• Treatment typically begins conservatively with rest, pain medication, physical therapy, and sometimes epidural steroid injections, with surgery reserved for severe or persistent cases, as reported in the study 1.

From the Research

Types of Disc Prolapse Involving Lumbar Vertebra

• Lumbar disc prolapse can be classified into different types, including:
  • Central disc prolapse: This type of prolapse occurs when the disc material protrudes into the central canal of the spine, potentially compressing the cauda equina nerve roots 2, 3, 4.
  • Lateral disc prolapse: This type of prolapse occurs when the disc material protrudes laterally, potentially compressing individual nerve roots 4.
• The degree of neurological deficit can also be used to classify cauda equina syndrome, including:
  • Bilateral radiculopathy: This occurs when there is compression of multiple nerve roots, resulting in pain, numbness, and weakness in both legs 2, 3.
  • Incomplete cauda equina syndrome: This occurs when there is partial compression of the cauda equina nerve roots, resulting in partial loss of sensation and motor function in the lower extremities 2, 3.
  • Complete cauda equina syndrome: This occurs when there is complete compression of the cauda equina nerve roots, resulting in complete loss of sensation and motor function in the lower extremities, as well as bowel and bladder dysfunction 2, 3, 4.

Clinical Symptoms of Disc Prolapse Involving Lumbar Vertebra

• Clinical symptoms of disc prolapse involving lumbar vertebra can include:
  • Low back pain: This is a common symptom of disc prolapse, and can range from mild to severe 2, 5, 3, 4.
  • Sciatica: This occurs when the disc prolapse compresses the sciatic nerve, resulting in pain, numbness, and weakness in the legs 2, 5, 3, 4.
  • Saddle anesthesia: This occurs when the disc prolapse compresses the cauda equina nerve roots, resulting in numbness in the perineal area 2, 3, 4.
  • Bowel and bladder dysfunction: This can occur when the disc prolapse compresses the cauda equina nerve roots, resulting in loss of control over bowel and bladder function 2, 3, 4.
  • Motor weakness: This can occur when the disc prolapse compresses individual nerve roots, resulting in weakness in the legs 2, 5, 3, 4.
• The timing of surgery can also impact the outcome of cauda equina syndrome, with some studies suggesting that urgent decompression may not always confer a benefit 6.