About A Fort Wayne Non-Contained Disc HerniationIntroduction Ruptured Disc! Herniated Disc! Extruded Disc! Oh my. You flinch at the sound of these terms because you have experienced the pain or know someone who has. The appropriate term for these types of herniated discs is "non-contained disc." Description The non-contained disc may cause back but usually pain into the extremities (one or both legs). This disc condition causes you pain because its nucleus pulposus (the center of the disc) has escaped through tears in the anulusfibrosus (the outer layers of the disc) and found itself in the spinal canal where it isn’t supposed to be. The anulusfibrosus no longer contains the nucleus pulposus. The non-contained disc irritates the spinal nerves with a chemical reaction or with pressure. Normally, the nucleus pulposus' fluid has never been in the spinal canal, and when it does enter, it causes a chemical reaction around the nerve to cause pain into the pelvis and leg.The nucleus pulposus' fluid chemically irritates the spinal nerves just by its mere presence in the canal, and, if enough of it escapes into the canal, its mass presses on spinal nerves causing pain into the leg. Check out this description of a non-contained disc herniation correlated with imaging. Non-contained discs (aka free fragment or extrusion) may be managed well conservatively. Non-contained lumbar disc herniations show better non-surgical relief than contained discs. (1) MRI helps in visualizing and monitoring the disc and nerve root changes while care is administered. (2) Nine of 11 non-contained discs shrunk 50% to 100% non-operatively. (3) Larger non-contained discs reduce the most. (4) Research notes spontaneous resorption of intradural disc material via macrophage and angiogenesis (the process of new blood vessels forming) within the disc. (5) As a matter of fact, free fragments (non-contained discs) absorb and decrease in size more than protruding (contained) discs. When the non-contained fragment moves, an even greater reduction in size is seen. (6) Phagocytes and cytokines play a role in helping resorb the non-contained disc. (7, 2) Examination A thorough, clinical examination that may include imaging is important to your recovery. Lumbar Spine Exam Description Treatment In-office, Cox Chiropractic Medicine Inc use Cox Technic Flexion Distraction and Decompression to lower the pressure in the disc and aid in the absorption of the free nuclear material that is irritating the nerve. Cox Technic also aids in the healing of the torn anular fibers and drives out chemicals that irritate and inflame the spinal nerves. Graphic Animation of Cox Technic - Lumbar Spine The disc is pressing on the nerve. Note that as the disc herniation reduces, the pinched nerve is relieved. This is an animation of the goal of Cox Technic Flexion-Distraction and Decompression: reduced irritation of spinal elements enough to relieve pain and help you regain your quality of life. The amount of decrease in size of the herniated disc necessary for pain relief varies from 0% to 100% for each individual patient. Cox Technic Protocol I - for severe pain or pain that extends below the knee Cox Technic Protocol II - for pain that is in the low back and stays above the knee Time to Improvement You must understand that it takes three months for a torn disc to heal well enough to allow you to return to daily activities like prolonged sitting, bending, lifting, twisting, etc. The first three to four weeks of concentrated treatment, therapies, and at-home care are designed to allow the best opportunity for the disc to heal quickly. This three month window does not mean that you must be treated continually throughout this time period, but means that you must be cautious and aware of your spine's healing. Recognize that even though the pain is gone, healing is still taking place and could be hindered if you do something to aggravate the process. In the 1000 cases study of patients undergoing care for their back pain, 91% reported maximum improvement in 90 days of care and 70% of patients in less than 30 visits. At Home Care At home you will want to avoid sitting for long periods of time, wear a support brace if recommended, take nutritional supplements that help rebuild disc cartilage, sleep on a supportive mattress, sit in an ergonomically designed chair, avoid constipation which just forces you to use pressure that your spine doesn't need, and modify your daily activities as needed. Exercise Tips Exercise is important to your recovery and prevention of future pain. It is important to start exercises as soon as possible, not vigorously, but gently. Do only exercises recommended. Do exercises only to your tolerance. Clinical Case Reports Pre and Post-surgical MRI Study of Lumbar HNP at L4-L5 and L5-S1 Following Non-traumatic Small Endoscopic Approach at L5-S1 only and The Application of Cox Disc Herniation and Stenosis Cases Demand Careful Clinical Examination and MRI Imaging Correlation: L3-4 Disc Herniation with Marked Motor Weakness, MRI Disc Herniation looks Small Upper Lumbar Disc Herniation with Central and Far Lateral Stenotic Changes Resulting in Anterior Thigh Pain L5S1 Disc Herniation Resolved with Cox Technic Large L5-S1 Disc Herniation Avoids Surgery with Cox® Technic Free Fragment: Large Sequestered Right L5-S1 Fragment & L5-S1 Subchondral Sclerosis of Bone with Degeneration of the L5-S1 Disc Free Fragment: L5S1 Free Fragment Free Fragment: The Osseoligamentous Free Fragment -- Challenging For All Physicians, Including The Manipulating Doctor: Right Far Lateral L5-S1 HNP Fragment Compressing Both L5 DRG And S1 Nerve Root Free Fragment: Sequestered L5-S1 Disc Treated & Relieved with Cox® Technic Protocols Protrusion: A Large L5S1 Disc Protrusion Treated Successfully with Cox® Technic Extrusion: Large Right L4-L5 Disc Extrusion Corrected with Reverse Cox® Flexion Distraction Manipulation - Protocol I MRI Misses Clinical Findings -- Left L4-5 Free Fragment with Only Low Back and Retrochanteric Pain Gemelli-Obturator Internus Complex Present and Treated Far Lateral Disc Herniation -- Extremely Painful -- Patient Chooses Surgery for Immediate Relief of Pain and Cox® technic for post-surgical management Pre and Post MRI Study of a 10mm Lumbar Disc Extrusion Treated with the Cox® Technic Large Extraforaminal L2-L3 Disc Herniation Treated Successfully with Cox® Technic Protocols: Always Treat Above the Disc Herniation Cox Distraction Treatment of Extruded L5/S1 with Neural Impingement, Disc Herniations at L2-L4 and Sciatic Radiculopathy and Paresthesia L5S1 Extruded Disc Relieved with Cox® Technic Decompression Spinal Adjusting Cox Technic Relieves Low Back and Leg Pain due to Two Discs - one extruded and one herniated Free Fragment: Free Fragment of Disc at L3-4 Relieved with Cox Technic Disc Extrusion Resorbed with Cox Technic Flexion Distraction System of Care L5 Radiculopathy from Large L4-5 Disc Extrusion Relieved 8.8mm Extrusion causes Low Back Pain, Leg Pain, Buttock Pain; Relief with Cox Technic Contact Cox Chiropractic Medicine Inc for gentle, relieving care of your lumbar spine non-contained disc herniation. References Cox, JM, Feller JA, Cox JA: Distraction Chiropractic Adjusting: Clinical Application, Treatment Algorithms, and Clinical Outcomes of 1000 Cases Studied. Topics in Clinical Chiropractic 1996; (3)3:45-59, 79-81 "This information and website content is not intended to diagnose, guarantee results, or recommend specific treatment or activity. It is designed to educate and inform only. Please consult your physician for a thorough examination leading to a diagnosis and well-planned treatment strategy. See more details on the DISCLAIMER page. Content is reviewed by Dr. James M. Cox I."