Column What are the causes of disc herniation? What is spontaneous healing? Pain expert explains.

What is disc herniation?

In order to better understand herniated discs, we will first explain step by step how the symptoms occur. 

What makes up an intervertebral disc

・The nucleus pulposus: a gel-like substance in the center of the disc that is mainly composed of water. 

・The annulus fibrosus: A mille-feuille-like layer mainly composed of collagen that covers the nucleus pulposus. 

Mechanism of disc herniation

1. Various factors, such as aging, can damage the intervertebral disc’s annulus fibrosus, and in turn the nucleus pulposus may escape through the wound. 

When the extruded herniated disc comes into contact with a nerve, symptoms of numbness similar to sciatic nerve pain are likely to occur. 

2. As the condition worsens, the nucleus pulposus is pushed out further and escapes the annulus fibrosus, causing the nucleus pulposus to fully project out toward the nerve. 

Under these conditions, in addition to numbness due to nerve damage, fresh nucleus pulposus components keep reacting with components in the vicinity of the spinal nerve. Abnormal material (the nucleus pulposus), which is not supposed to be there, is squeezed into the spinal cord and triggers an immune response in the human body, in turn causing inflammation and pain.

There is another type of herniation called sequestration, where the herniated nucleus is completely detached from the intervertebral disc.

Spontaneous Healing of Herniated Discs

Although it can often be found mentioned on the internet, there are only few pages that properly explain the spontaneous healing of herniated discs.

First, let us address the question of whether herniated discs can heal spontaneously or not:

Not all herniated discs can heal spontaneously, as there are certain conditions for a herniated disc to heal spontaneously.

The conditions are as described above in “What is a herniated disc?”. Namely that:

The nucleus pulposus must be in contact with the spinal cord and an immune reaction must occur.

Therefore, even in the presence of a herniated disc, if the nucleus pulposus does not protrude from the annulus fibrosus and does not touch the spinal cord, the immune reaction does not occur, and the disc will not heal spontaneously.

If a disc heals spontaneously, can it be left untreated without consequence?

After reading this far, what do you think? Do you think there might be a problem?

The answer is yes. There is.

Even if a herniation heals spontaneously, the nucleus pulposus can be squeezed out and herniate time and time again as long as the damaged annulus fibrosus is not healed.

It may be easier to understand if you think of it as a flat tire. If you don’t plug the hole in the tube, the air will keep leaking out of the hole. 

So, what can be done to treat it?

Unfortunately, there are few treatments in Japan to repair a damaged annulus fibrosus.

There are surgical procedures such as resections or laser therapy, and recently, a treatment called Hernicore – but it only removes the herniated portion, or shrinks it by decompression, and it cannot repair the annulus fibrosus.

In Japan, there has been progress in the direction of minimally invasive removal and reduction of herniated discs, but I do not think that progress has been made in the direction of treatment of the root cause of disc herniation.

The mechanism and treatment of herniated discs have been studied around the world, and the necessity of repairing the damage to the annulus fibrosus is well recognized, but the treatment method for this had not yet been introduced to Japan yet.

Through years of hard work and negotiation, we have succeeded in finding a treatment method that can repair the disc and have incorporated it into our treatment methods. The Cellgel method uses a special medical device called DiscoGel, which also known as “Gelified ethanol” overseas. It is a treatment method that is used all over the world and has gathered solid evidence in its favor. If you would like to see more information about this treatment in overseas links, you will find a wealth of information by searching for keywords such as “DiscoGel Disc” or “Gelified ethanol Disc.

For reference, here is our clinic’s page on the Cellgel method.

https://en.ilclinic.or.jp/wp/treatment/cellgell

※The Discogel used in the Cellgel method is a medical device that has not yet obtained approval under the Pharmaceuticals and Medical Devices Act, but has been legally authorized for import by “private import by a physician”. In Japan, unapproved medical devices may be used under the responsibility of physicians.

I hope you enjoyed our explanation.

In summary:

• Removing or reducing the size of a herniated disc will not treat the root cause of the disc herniation.
• Herniated discs may heal spontaneously, but the risk of recurrence remains high if the underlying cause (damage to the annulus fibrosus) is not cured.
• Treatments that can cure the damage to the annulus fibrosus are almost nonexistent.

That is all. I hope this will be of help to some of you.

This article was written by: Tadaaki Minowa, Director