1.Are small discs protrusions in c2/3,c3/4 and c4/5 considered
herniated discs in middle age man?2. What’s the difference between protrusion
discs and extrusion discs and are both considered herniated discs?
3.What does degenerative changes in cervical spine means?
4. Are osteophytes in cervical spine formed as result of degenerative changes
or as result of trauma accidents,like auto rear end accidents?
5. What does “uncovertebral joint hypertrophy” at c3/4 in middle age man
means(and usually what causes it)?Thank you.
Dr. Joshua’s Answer:
Sorry for the delay in answering - I have been working over the weekend.
There is no consensus on the usage of the terms “herniation”, “protrusion”, and “extrusion”. I cannot say for sure what your doctor means when he talks about them. Generally, “bulging” means that there is disc degeneration and weakening of the outer layer (annulus fibrosus) of the disk, allowing the disc to “bulge” towards the spinal canal. Protrusion is sometimes used synonymously with bulging, and for clinical purposes I think this is OK. Some others consider “protrusion” a more advanced stage and more synonymous to “herniation”, or “prolapse”, or “extrusion”. This is a semantic jungle.
Let me clarify this a bit. For practical purposes, and for clinical relevance, I consider bulging and protrusion similar. When small, they are contained fully or mostly by the outer layer (annulus) of the disc and/or the ligament (posterior longitudinal) which lies between the disc and the spinal canal. Clinically speaking, bulging or small protrusion are unlikely to cause symptoms.
Extrusion (I never use this term) may point to a more serious problem, and I use the term “herniation”, or “prolapse” when the inner tissue ruptures (herniates) through the outer tissue and enters the spinal canal. Now we may have problems: the herniated pulpous tissue both compresses and chemically irritates the nerve root, causing radicular symptoms (radiating pain, weakness).
So to recap - when I talk about prolapse, or herniation, there is usually clinical relevance and symptoms. Small disc protrusions and bulging on the other hand are quite common findings in middle-aged people, and mostly do not cause symptoms.
Symptomatic disc herniation is not as common at the C2-5 level as it is at the C5-7 level. Without seeing your MRI, I would guess your small protrusions at the C2-5 level are of no consequence.
Degenerative changes in the cervical spine are common and mean the changes that occur in the bones, ligaments and joints due to “wear and tear”. Some are more susceptible to degenerative changes than others. We don’t know why. The changes include disc degeneration, bone spur formation (osteophytes) and joint destruction and hypertrophy. Hypertrophy means excessive growth. The joint becomes larger due to the grinding forces that it is subjected to when the shock-absorbing discs have degenerated, i.e. worn out. The grinding and movement induce bone and connective tissue growth, and fluid may accumulate in the joint. Osteophytes are formed early on in the degenerative process, and they are not caused by trauma, but trauma such as car accidents and whiplash injury can make the degenerative process worse.
Intervertebral joint hypertrophy may also cause compression of nerve roots and consequently pain and numbness in the corresponding region.
Surgery is needed when a) there is radiological evidence of nerve root or spinal cord compression - AND - b) the distribution of symptoms (radiating pain/numbness/weakness) matches exactly the radiological findings (e.g. C5-6 prolapse on the MRI - thumb numbness/arm pain/biceps weakness)
Cervical spine surgery should be done under an operating microscope. Surgery will not help local neck pain and should not be offered as treatment for neck pain.
Check out the National Libraries of Health page for more information on cervical spondylosis:
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