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Determining treatment of lumbar disk protrusion and disk extrusion: a single case study demonstrates the difference, and differing needs.

Article Excerpt
Disk herniation is a common spine disorder that has a wide range of presentations and clinical significance. (1,2) The potential for recovery varies from patient to patient, depending on the size of the protrusion, the size of the canal, the patient's age and activity level, and the extent of disk disruption. (3) Often, radiologists use vague terms to describe the herniation, and the literature is not helpful in characterizing what types of herniations are likely to benefit from what kinds of treatment. Because different forms of herniation may represent both a different aspect of disk deterioration and a different indication for treatment, comparisons can help physicians understand the relative indications for surgery.

This single case study demonstrates the differing clinical presentations that determine treatment of lumbar disk protrusion and disk extrusion. In this article, I describe the case of a patient who presented with a bulging disk and then later with disk extrusion. I discuss the principles that guide proper treatment and offer an algorithm for a conservative exercise program.

CASE PRESENTATION

Bulging disk

A 38-year-old man first presented to the spine clinic for evaluation of herniated nucleus pulposus (HNP) after his local physician obtained an MRI scan of his lumbar spine. The patient was in excellent health, a nonsmoker, and fully employed at a job that involved frequent lifting and trunk twisting. About 6 months before his referral, he had begun to experience episodic and then more persistent low back pain (LBP) that often became severe at the end of the day. He found that bending and twisting aggravated the LBP symptoms and that prolonged sitting was becoming painful as well.

Within the previous...

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