From the Guidelines
Lumbar disc protrusion typically occurs posterolaterally, where it can compress nerve roots exiting the spinal canal, causing symptoms such as low back pain, sciatica, numbness, tingling, or weakness in the affected leg. This location is significant because the posterior longitudinal ligament is weaker on the sides, making lateral protrusions more common, and because nerve roots travel through this area before exiting through the intervertebral foramen 1. Symptoms most commonly develop when the protrusion occurs in this area, where it can press on nearby nerves. According to a study published in the Journal of the American College of Radiology, nonspecific lumbar disc abnormalities, including disc protrusions, are common in asymptomatic patients and can be demonstrated readily on MRI, CT, fluoroscopic myelography, and postmyelography CT of the lumbar spine 1.
Key Points to Consider
- The prevalence of disc protrusion increases with age, from 29% in those 20 years of age to 43% in those 80 years of age, even in asymptomatic patients 1.
- Imaging abnormalities can be seen in a substantial number of people without back pain, and routine imaging provides no clinical benefit in patients with acute, uncomplicated low back pain 1.
- Treatment usually begins conservatively with rest, physical therapy, anti-inflammatory medications, and possibly muscle relaxants, with most disc protrusions improving within 6-12 weeks 1.
- Persistent symptoms or neurological deficits may require surgical intervention, such as microdiscectomy to remove the protruding disc material 1.
Clinical Implications
- The location of lumbar disc protrusion is crucial in determining the symptoms and treatment approach, with posterolateral protrusions being more common and causing more significant symptoms 1.
- Clinicians should be cautious when interpreting imaging results, as nonspecific lumbar disc abnormalities are common in asymptomatic patients, and routine imaging may not provide clinical benefit in patients with acute, uncomplicated low back pain 1.
From the Research
Location of Lumbar Disc Protrusion
- The location of lumbar disc protrusion where people typically experience symptoms is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 6 mentions that the location of herniation with regard to the midline is a significant factor in predicting the need for surgery in lumbar disc herniation.
- Specifically, the study found that more laterally located discs are associated with a higher risk of conservative treatment failure 6.
- Study 5 also mentions that the protrusion percentage and resorption of protrusions are important factors in the treatment of giant lumbar disc herniation, but it does not provide information on the specific location of the protrusion.
- Study 3 discusses the effects of a complex rehabilitation program on reducing pain and disability in patients with lumbar disc protrusion, but it does not provide information on the location of the protrusion.
- Study 4 provides a narrative review of non-surgical approaches to the management of lumbar disc herniation associated with radiculopathy, but it does not discuss the location of the protrusion.
- Study 2 evaluates the long-term effect of a specific conservative treatment method for patients with lumbar disc prolapse, but it does not provide information on the location of the prolapse.
Factors Associated with Lumbar Disc Protrusion
- Several factors are associated with lumbar disc protrusion, including: