What actually happens to a herniated disc?

November 16, 2023 3:22 PM

I have a herniated disc, as discussed here. What is actually going to happen to it over time from a physiological standpoint?

YANMD obviously, but my question is maybe more scientific than anything. According to an MRI, here's what I have going on:

At the L5-S1 level, there is a large broad-based midline to left lateral disc extrusion superimposed on circumferential disc bulging and facet hypertrophy, resulting in obliteration of the lateral recesses and overall moderate to severe spinal canal stenosis.

So I've been to an orthopedist and a chiropractor and a physical therapist each several times, and of course I've been pursuing my own M.D. through Google and YouTube. And yet, I can't find any answer to my questions that isn't either evasive, non-committal, or contradictory to other sources' answers.

So here's what I've been asking and not getting clear answers to:

• Might the extruded part of the disc eventually go back inside the disc?
• Might the herniated disc seal back up at some point, with or without the extruded part coming back home?
• Might the extruded tissue just sort of dry up and hang out in my body for the rest of my life?
• Does the nucleus of the disc grow back, or do you just have a finite amount for your whole life?
• Are my lymphatic and immune systems just sort of attacking the extrusion right now? Is this part of why I'm in pain?

My sense with all of the practitioners in my life is that they hate fielding questions about the underlying structural cause and healing of this thing, because regardless of cause and prognosis, the interim answer are all just "time and pain meds and PT and, if you're a Sarno guy, journaling."

In other words, the reason I had to fight so hard for an MRI was because they didn't care about the cause of my sciatica since the solutions short of surgery are all the same. But when pain is your constant companion, you do tend to get more curious about what is causing it and what is happening with it. I want to know what's going to happen to my "obliteration" over time.

posted by kensington314 to Health & Fitness (10 answers total)

Best answer: I had a microdiscectomy for two very large ruptures at L5-S1 about 3 years ago. Here's what my doctors and surgeon told me:

*The disc bulges and fluid or any other material in there *might* get reabsorbed over time. Nobody had a good idea of timeline on this, other than to say it would take a very long time. In the meantime, the added material could/would likely continue to create pressure and therefore, pain.

*I don't believe the disc grows back. There are procedures to deal with it when it's gone, but my surgeon said that spacers in between vertebrae aren't commonly used because they fail.

*There might be some material released into your lymph/bloodstream that your body is attacking, but it's impossible for us to tell if that's the proximal cause of your pain.

Having been in your shoes--your exact shoes--I'd ask for surgery. Absolutely, no questions asked. I was in so much agony that I couldn't lie flat for an MRI without being hopped up on the maximum biologically tolerated dose of hydrocodone. And I STILL couldn't make it through the longest cycle on the machine.

Talk with an orthopedic surgeon if you can. And whatever else you do, please stop with the chiropractors. They're just taking money from you and making you more uncomfortable.
posted by yellowcandy at 4:25 PM on November 16, 2023 [4 favorites]

(and if it helps, I was back to playing tennis within 10 weeks of surgery for what my surgeon called "the worst ruptures I've seen since I started practicing 30 years ago." Three+ years on, I'm still playing tennis and have been about 99% pain free.)
posted by yellowcandy at 4:27 PM on November 16, 2023 [2 favorites]

My husband had an excruciating herniated disc at about the same level. It took a couple of weeks at home flat on his back, but the herniated area of his disc healed by itself without any surgery and he was actually, seemingly miraculously, absolutely fine after about 5 weeks. It seemed impossible considering that he was writhing in pain on the orthopedist's floor at his first visit, but it's true.

I hope you have the same outcome.
posted by citygirl at 5:42 PM on November 16, 2023

Best answer: Having been in similar to you shoes (herniated disk, fighting for an MRI, very painful sciatica requiring three steroid shots to get under control), this is my understanding, from what my doctors told me. I am not a medical professional, so just recounting my understanding

- hernias do shrink over time, however, leave the area more vulnerable each time (as the space / buffer between the vertebrae decreases, as the "jelly" is not replenished)

- every single specialist I saw told me that correlation is not necessarily causation with herniated discs and sciatica. I was told that many people walk around with herniated discs without experiencing any pain, and they only get discovered on an MRI when sciatica pain results in imaging, but that herniated discs do not necessarily cause pain, and sciatica may or may not be a result of a herniated disc

- Unlike what the poster above me said, my understanding is that it is better to avoid the surgical route unless it is absolutely a last resort

- Also, in my experience, my chiropractor has been invaluable for pain relief (of course all chiropractors are not created equal). And whether or not you think that chiropractic in general is quackery, chiropractic manipulation for lower back pain is literally the one application of chiropractic care that is validated by mainstream medical establishment.

I wish you speedy healing! I had extremely painful sciatica for almost 8 months, to the point where I would cry when I had to get up from a sitting position, but a combination of steroid shots, PT, and chiropractic sorted me out, and I was even able to slowly go back to deadlifting and doing other strength exercises that involve the lower back.
posted by virve at 6:39 PM on November 16, 2023 [3 favorites]

I had a ruptured disc at L5-S1 nearly 20 years ago when I was still a young adult. I think that I had a herniated disc for a long time before that, which would cause me pain when I went into a very specific position or when I'd twist it the wrong way-I'm pretty sure that was the case for at least 5 years. It never resolved, but I managed. This was also when I was most fit and active. Then it ruptured, and I knew exactly when it ruptured - I was lifting a heavy tire into a car trunk and I had clear excruciating pain and then over the course of the next 24 hours my leg went completely numb. I eventually had surgery after trying pt, steroid injection, flat back rest. Someone (probably the surgeon) told me that the disc jelly itself can be irritating to the nerves and cause significant pain.
posted by sulaine at 6:51 PM on November 16, 2023 [1 favorite]

Best answer: Are my lymphatic and immune systems just sort of attacking the extrusion right now? Is this part of why I'm in pain?
I was prescribed prednisone (60mg for 3 days, tapering to 50 mg for 3 days, 40mg for 3 days, 30mg for 3...) for a less-severe L5-S1 herniation. Rheumatology said my pre-existing autoimmune issues worsened the pain, and I started feeling better 2 days into the course. (I was also prescribed p/t.)
posted by Iris Gambol at 10:21 PM on November 16, 2023

It might be worth exploring https://www.painscience.com/

I've found the articles useful for thinking about my low back pain (and various other kinds of musculoskeletal pain that I get). The articles are well cited, supportive of the person experiencing pain, and updated frequently with new citations and information.
posted by eekernohan at 5:45 AM on November 17, 2023

Anecdotally I had a herniated disc in L4/L5 about 15 years ago in my mid-20s, with sciatica for the better part of a year. Did PT for months with no result until a new PT put me on a traction machine that pulled the lower half of my body away from the upper half (think straps on your torso and hips pulling the two apart gently) - sciatica was 85% resolved within a few weeks of starting that. I've had lower level sciatica on and off in the years after, mostly in the morning when stiff. But actually recently, like the last couple of years, I really haven't noticed it at all. My theory is that the disc has either been reabsorbed somewhat or sort of dried out so it's no longer touching the nerve? Super unscientific answer to your question. I hope things improve! Don't be afraid to try different treatments until you find one that works, it seems very individual how these things resolve.
posted by knownfossils at 7:44 AM on November 17, 2023

My herniated disc is between the L4 and L5 vertebrae. It mostly affected my left leg (pain, weakness, loss of range of motion). The MRI looked like the disc had melted and oozed down the side of the vertebra. It seemed I was an obvious surgery candidate. But before that would be approved I spent a while taking meloxicam and gabapentin. Then I was given a cortisone injection, an experience so incredibly painful that I would rather die than undergo it again (never made the appointment for the second). To make things worse, the cortisone lasted all of two weeks before the pain returned and I went on the meds again.

I went to physical therapy and that did an amazing job of strengthening my left leg and improving the range of motion. I still do some of the exercises multiple times each week. I also go to my chiropractor weekly and get massage therapy on a monthly basis (it was more often early on). I had to stop running and training in karate but took up cycling once I was sure I could do it without causing any pain (I eventually found a karate teacher willing to work with my issues and I'm back doing that as well). I believe the exercise has done a lot to help my leg function.

I was concerned about the long-term effects of a strong NSAID like meloxicam and tapered off it after about 6 months and the gabapentin shortly after. I still have some minor issues with my leg when I walk but you'd only know if you knew me from before. I sometimes feel a little discomfort when lying flat in bed and occasional leg pain but rarely enough now that I usually can't remember the previous time it happened.

This happened in 2018, so I know I'm an outlier and there are no guarantees but it's possible to avoid surgery in some cases. Don't be afraid to get more than one opinion before considering any treatment, surgical or otherwise.
posted by tommasz at 2:50 PM on November 17, 2023

Best answer: Might the extruded tissue just sort of dry up and hang out in my body for the rest of my life?

I was told something not too far from this by a doctor early on in my herniation career. he said that although I could expect to have recurring debilitating lower back episodes throughout my life (as indeed I do continue to have), as I got older they would eventually get less severe because as you get older & creakier all the junk cushioning your discs dries up a bit so there is just less material in there to be extruded, which means less pressure on the nerves when it comes out.

this sounded completely insane to me at the time because one associates bad backs with getting older. but it seems to have been true even if they simplified the explanation to the point of nonsense. the back falls apart a few times a year but the effects are measurably less debilitating than they were ten years ago, no more electricity or falling down. something has either shrunk or been reabsorbed or just shifted a millimeter in the right direction.

as to whether it is still accurate to say I have herniated discs or whether this modest but steady symptom improvement means they technically unherniated themselves at some point, I have no idea, no doctor has ever answered this direct question when I asked it. if it is possible for that to happen, another MRI is the only way to know.

for reasons I do not understand, this does not apply to cervical discs, only lumbar ones. neck herniations do not get better as you get older. oh boy do they not.
posted by queenofbithynia at 5:34 PM on November 17, 2023 [1 favorite]