I Suffered A Minnesota Workers Compensation Injury. Do I Need Back Surgery?

Though I've been a Minnesota workers compensation attorney my entire legal career, that's the very same question I asked myself nearly 20 years ago.  Do I need lumbar spine surgery.

I was injured at work and despite conservative care, my radicular leg and back pain left me unable to sleep and barely able to function.  Over time I grew frustrated, short tempered and frightened about my future.  Despite being a young lawyer, I was worried that I wouldn't be able to do my job given my inability to sit or stand for extended periods of time; a prerequisite to being a trial lawyer.  I was taking narcotic medications that left me fuzzy at best and only took the edge off my pain.  I want to share with you what I've have learned over the past few decades since my injury and lumbar spine surgery.

Over the years I have handled or represented over a thousand cases involving spinal cord injuries.  I'm unique in being the only Minnesota work comp attorney who has sustained a spinal cord work related injury.  In fact, I have undergone three spinal surgeries since 1992.  Lucky me right?  Twentyfive years later spine surgeries have dramatically changed and in most cases improved.  During this time I have seen aggressive use of lumbar and cervical fusions, the introduction of artificial discs, and development of spinal cord stimulators.

Most lawyers are hesitant to offer advice on surgery because they haven't had the same.  Though I'm a workers compensation attorney, I feel obligated to be a "counselor" as well.  I encourage my clients to explore conservative treatment and only enter into the decision of spinal surgery after the same.  I also make sure that they understand that though surgery can relieve their symptoms, in rare situations their conditions could worsen.  I offer the names of physicians and clinics that have a proven track record of having, "good hands, good heads and good hearts".  I consider myself lucky that my surgeries have turned out extraordinarily well.  I am 100% pain free.

I often blog that not all workers compensation attorneys are equal and that experience matters.  This applies to orthopedic surgeons and neurosurgeons as well.  Like some lawyers I know, a surgeon may come across as confident and a smooth talker.  This doesn't mean they are either good in the courtroom or in the operating room.  Surgeons can be overconfident of their talents and fail to communicate or even know the long term outcome of their surgical patients.  Very few have patient follow up beyond 3-6 months post surgery.  If the patients having ongoing or worsening pain and are non surgical there is usually nothing a surgeon can offer you and they wash their hands with you.  In fact, in many cases the last time you see your surgeon is just before the surgery or while recovering at the surgical center or hospital.  Often follow up care is performed by nurse practitioners or physicians assistants.  Remember; "good hands, good heads and good hearts".  It's rare to find a surgeon with both.

If you sustained a work injury and want to discuss the surgery, I'm happy to sit down with you for free and listen and discuss with you your options.  A decision to undergo surgery is a personal decision and I will never tell you to do the same.  I will simply share with you what I have experienced personally and in the thousands of workers compensation cases I have been involved with over the last 25 years.  With this information you can hopefully make a more informed decision of what is best for you and your family.  Contact us today at 651-333-3636 for a free consultations.  Every single one of our attorneys has been honored as a Superlawyer and is a workers compensation expert.  Visit us at www.mndisability.com for more information.  Also visit our video center for answers to many of your questions.  Our phones are answer 24/7 and in many cases you can talk to a lawyer anytime of the day or night.

Can The Work Comp Insurer Cut Off My Pain Meds?

Recently the Minnesota Department of Labor and Industry erected hurdle for injured workers using pain medications following a Minnesota workers compensation injury.  The purpose of the change is allegedly two fold; first to reduce costs for insurers and second to stem pain medication abuse.  Having undergone three spine surgeries myself, I know first hand the benefits of narcotic medications.   Recovery from surgical procedures can be brutal.  However, I think that insurance companies have led the way in pushing for these changes for one reason.  Can you guess?  Correct, it's to save money.

Can insurance companies therefore stop paying for your pain meds?  The quick answer is maybe.  But with sound legal advice you can successfully fight them.  As with all medical treatment and benefits, it's critical that your doctors not only document why they are prescribing a particular medication but also follow the newly enacted guidelines.  The new guidelines require your doctor to do the following:

• Affirm that you can't maintain functions of daily living without the medication, don't have "somatic symptoms disorder", don't have a history of failure to comply with treatment, and no history of substance abuse.
• Ensure all other forms of pain management options have been exhausted.
• Identify whether there are factors that could complicate your use of narcotic medications; pregnancy, suicide risk, history of substance abuse, heart issues, etc.
• Complete a "scientific assessment" to determine your risk of abuse.
• Explain potential complications of using long term pain pills.
• Finally you must enter into a written contract with your physician which includes the possibility of random drug testing.

At Atkinson Law Office we have created an easy form for your physician to complete.  This ensures that there is no interruption in medications.  Usually once your doctor completes this form, our attorneys can work with your insurance company to continue your medications.  They may have you see an "independent medical examination" by an adverse doctor.  If you receive notice of the same CALL AN ATTORNEY IMMEDIATELY.  This means they will be cutting off your meds very soon. The lawyers of Atkinson Law Office have successfully litigated numerous cases and successfully helped clients have a quality life despite significant injury.  If you would like to discuss this or any other workers compensation questions with a Minnesota workers compensation expert, call today at 651-333-3636.  Our phone are answered 24/7.  We represent clients across the entire state of Minnesota.

Can I Be Fired For Reporting A Workers Compensation Injury?

If an employer fires you or threatens to fire you for reporting a work injury they are in violation of Minnesota Statute 176.82; 

"Any person discharging or threatening to discharge an employee for seeking workers' compensation benefits or in any manner intentionally obstructing an employee seeking workers' compensation benefits is liable in a civil action for damages incurred by the employee including any diminution in workers' compensation benefits caused by a violation of this section including costs and reasonable attorney fees, and for punitive damages not to exceed three times the amount of any compensation benefit to which the employee is entitled. Damages awarded under this section shall not be offset by any workers' compensation benefits to which the employee is entitled."

It's rare that an employer is stupid enough to commit a violation of Minnesota law but it does happen from time to time.  I strongly urge injured workers to pursue these claims which we refer to as "82 Actions".  To deter an employee from filing a work injury is unconscionable as best and illegal at worst.  I have seen cases where employers, supervisors and co workers have actually convinced seriously injured workers to tell a emergency doctor that their injury did not happen at work.  Telling them the company will lose jobs, workers will lose bonuses, and they will "take care of you".  BULLSH!T They are liars.

If you have been injured at work ANY DELAY in reporting the injury or seeking treatment will often result in a denial of your claim by insurance companies and without an experienced lawyer your claim may also be denied by a workers compensation judge.  If you have been hurt the first thing you should do is seek medical treatment and tell the doctor exactly how you were hurt or the pain developed, then report the injury, and finally contact an attorney!  Consultations with any workers compensation lawyer are free and the good lawyers like those at Atkinson Law Office will never, ever pressure you to hire an attorney.  We explain your rights, recommend a course of action and YOU decide what to do.

If you have been hurt contact the Minnesota workers compensation experts at Atkinson Law Office today for a free, no obligation consultation.  Call us at 651-333-3636 and visit our website at www.mndisability.com.

Is An Indpendent Medical Examination Really Independent?

What do you think? NO an independent examination is not independent but rather ADVERSE to your interests and those of your treating physicians.

I have previously posted on this issue months ago but it is such an important issue, I think it's necessary to discuss this issue once again. There is NEVER a good intention on the part of an insurance company in having you seen by THEIR doctor for an "independent" medical examination. The intent is to cut off your benefits and limit their exposure PERIOD!

As a former insurance company attorney I have schedule hundreds of "independent medical examinations" for injured workers. The term independent medical examination is not always accurate. Though there are reputable doctors who will perform a thorough examination and write a neutral report, there are many who will do and say almost anything. Many defense attorneys believe it is their job to chose the " doctors who will do and say almost anything"!

When I worked as a defense attorney I thought having a neutral independent doctor was truly important. It helped me assess and fully understand the injured worker's claim. It also established credibility before the compensation judges. Later in my career as a defense attorney I began to get flack from a kool-aide drinking "old time" defense lawyer who chastised me for choosing these independent physicians and telling me I needed to get on board and work with the "adverse examiners". Despite the fact that this attorney had only gone to a full hearing a handful of times in the past decade, he was going to try his hardest to win a case at almost any cost! This didn't sit well with my years of experience and the reputation I developed. This was one of the reasons I now represent only injured workers and share these stories.

An employer and workers compensation insurer have the right to have you seen for an independent medical examination or adverse examination regardless of whether your claim is admitted or denied. They need to reimburse you for your expenses and must schedule it within 150 miles of your home. Keep in mind that this doctor is not nor will he ever be your treating physician. There is no doctor patient confidentiality, everything you tell the doctor will be shared with the employer and insurer. Sometimes the examinations last a few minutes and other times they can take close to an hour with an extensive physical examination and questions.

You will usually receive the report as an attachment to a service of Maximum Medical Improvement or a Notice of Intent to Discontinue Befits in the mail. As this is the goal of the adverse examination, your medical and/or wage loss benefits will likely be stopped as the result of your "independent medical examination". In addition the report will likely maintain that your current medical treatment is unnecessary.

As a defense attorney I understand the flaws in these reports and the mistakes that can be made in preparation for the same. As your attorney I will surgically dissect these reports and the accompanying letters providing the physician with "foundation" or their opinion. My job is to look for contradictory medical evidence and obtain an opinion from your own treating physician and if necessary a truly independent doctor. If you would like to discuss your claim in more detail, feel free to contact me directly at 651-333-3636. All calls are returned within a few hours. Don't be afraid to contact me after hours as I personally return all calls.

You may also visit our web page at www.mndisbility.com

Exploring Back Surgery - Part III

A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery, and all involve adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment.

For patients with the following conditions, if abnormal and excessive motion at a vertebral segment results in severe pain and inability to function, a fusion may be considered

• Isthmic, degenerative or postlaminectomy spondylolisthesis.

Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine (caused by infections or tumors), fractures, scoliosis or deformity.

How spine fusion surgery works

At each level in the spine, there is a disc space in the front and paired facet joints in the back. Working together, these structures define a motion segment and permit multiple degrees of motion. Two vertebral segments need to be fused together to stop the motion at one segment, so that an L4-L5 (lumbar segment 4 and lumbar segment 5) spinal fusion is actually a one-level spinal fusion.

A spine fusion surgery involves using bone graft to cause two vertebral bodies to grow together into one long bone. Bone graft can be taken from the patient's hip (autograft bone) during the spine fusion surgery, harvested from cadaver bone (allograft bone). or manufactured (synthetic bone graft substitute).

In general, a lumbar spinal fusion surgery is most effective for those conditions involving only one vertebral segment. Most patients will not notice any limitation in motion after a one-level spine fusion. Only in rare cases should a three (or more) level fusion surgery for pain alone be considered, although it may be necessary in cases of scoliosis and lumbar deformity.

When necessary, fusing two segments of the spine may be a reasonable option for treatment of pain. However, spinal fusion of more than two segments is unlikely to provide pain relief because it removes too much of the normal motion in the lower back and places too much stress across the remaining joints.

There are several types of spinal fusion surgery options, including:

• Posterior lumbar interbody fusion (PLIF/TLIF))—the procedure is done from the back and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

• Posterolateral gutter fusion—the procedure is done through the back

• Anterior lumbar interbody fusion (ALIF)—the procedure is done from the front and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

• Anterior/posterior spinal fusion—the procedure is done from the front and the back

Exploring Back Surgery - Part II

Like some of my clients, I sustained a work related back injury resulting in the need for surgery. In Part II of Exploring Back Surgery, I will discuss the procedure I underwent to repair a large free fragment disc herniation in my back.

A discectomy is a surgery done to remove a herniated disc from the spinal canal. When a disc herniation occurs, a fragment of the normal spinal disc is dislodged. This fragment may press against the spinal cord or the nerves that surround the spinal cord. This pressure causes the symptoms that are characteristic of herniated discs.

The surgical treatment of a herniated disc is to remove the fragment of spinal disc that is causing the pressure on the nerve. This procedure is called a discectomy. The traditional surgery is called an open discectomy. An open discectomy is a procedure where the surgeon uses a small incision and looks at the actual herniated disc in order to remove the disc and relieve the pressure on the nerve.

How is a discectomy performed?
A discectomy is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards.

In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy.

Once this bone and ligament is removed, your surgeon can see, and protect, the spinal nerves. Once the disc herniation is found, the herniated disc fragment is removed. Depending on the appearance and the condition of the remaining disc, more disc fragments may be removed in hopes of avoiding another fragment of disc from herniating in the future. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a bandage is applied.

What is the recovery from a discectomy?
Patients often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Patients often spend one night in the hospital, but are usually then discharged the following day. A lumbar corset brace may help with some symptoms of pain, but is not necessary in all cases.

What is endoscopic microdiscectomy?
This is a newer technique utilized by my surgeon. This technique may allow your surgeon to perform a procedure called an endoscopic discectomy. In an endoscopic discectomy your surgeon uses special instruments and a camera to remove the herniated disc through very small incisions.

The endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection. Your surgeon uses x-ray and the camera to "see" where the disc herniation is, and special instruments to remove the fragment.

Exploring Back Surgery - Part I

As many of your are aware, I am the founder of Minnesota Disability and Atkinson Law Offices where I offer nearly two decades of experience handling workers compensation matters. What you may not know is that like some of you, I have suffered from a workers compensation injury that resulted in back surgery.

Though my surgery has had many positive results, I unfortunately have ongoing complications. In this series of articles I want to explore the types of back surgeries that may be recommended to those of you with chronic back pain in an attempt to answer some of your questions. Surgery is a very serious procedure that can have profound benefits for certain individuals. However, surgery is something that has the potential for downsides and careful consideration must be taken before undertaking the same.

In Minnesota there are currently 6 forms of back surgery that are being performed in most major hospitals. They range from the most common procedure, diskectomy, to the newest and least well know, the artificial disk.

Diskectomy. This involves removal of the herniated portion of a disk to relieve pressure on a nerve. It's done as an open surgery, and typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.

Laminectomy. This procedure involves the removal of the lamina that overlays the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.

Fusion. Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture or when there's excessive motion between vertebrae. It may also be used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.

Intradiscal electrothermal therapy (IDET). In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation.

Vertebroplasty. During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar procedure — called kyphoplasty — a balloon-like device is inserted to expand compressed vertebrae before bone cement is injected.

Artificial disks. Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. These relatively new devices are still being studied, however, so it's not yet clear what role they might play as a back surgery option.

GET PROMPT MEDICAL TREATMENT WITH PROVIDER OF YOUR CHOICE

An employee is entitled to payment of medical, psychological, chiropractic, and other treatment for a work-related condition. Minn. Stat. §176.135. This includes any treatment which is reasonable and necessary to cure and relieve the effects of a work injury.

Almost without exception, the injured worker has the absolute right to choose his or her treating doctor for a work injury. The employee can change doctors within 60 days after medical treatment has commenced, without getting the permission of the employer, insurer, or other interested parties. Minn. Rule Part 5221.0430, Subpart 2. After 60 days, the employee can change primary doctors, but only with the permission of the employer and insurer, or by seeking approval of the court. The rule provides that the employee may not change primary doctors if:

(a) A significant reason for the request is to block reasonable treatment or to avoid returning to work;

(b) The change is to develop litigation strategy rather than to pursue appropriate diagnosis and treatment;

(c) The provider lacks the expertise to treat the employee for the injury;

(d) The travel distance to obtain treatment is an unnecessary expense and the same care is available at a more reasonable location;

(e) At the time of the employee's request, no further treatment is needed; or

(f) For another reason, the request is not in the best interest of the employee and the employer.

In other words, even if the employee's initial treatment is at an emergency room or at an occupational medicine clinic favored by the employer, the employee can change doctors within 60 days. Choosing a qualified physician is important. A general orthopedic surgeon may not be you physician of choice if you have a complex hand injury. There are specialties within specialties and attorney Thomas Atkinson with Minnesota Disability can help you sort through this complex system.

Back & Neck Pain - Part II

Facet Joints

Lumbar facet joint are small pairs of joints on the back side of the spine where the vertebrae meet. These joints provide stability to the spine by interlocking two adjacent vertebrae. Facet joints also allow the spine to bend forward (flexion), bend backward (extension), and twist.

Inflammation of facet joints can occur from injuries or from arthritis. Many times, particularly in the case of injuries, one may not see abnormalities on an x-ray or MRI.

Spinal Stenosis
The term lumbar stenosis refers to any narrowing of the spinal canal. There are many causes of spinal stenosis; the most common is degeneration of the spine, which occurs almost inevitably as a part of the aging process.

Several factors contribute to the narrowing of the spinal canal with degenerative changes. First, wear and tear causes the facet joint to enlarge into the spinal canal. Second, the major ligament of the spinal canal, the ligamentum flavum, undergoes hypertrophy (enlargement) and buckling. Third, the intervertebral discs may bulge backwards or herniate into the canal. Fourth, the vertebrae may slip forward in a condition called spondylolisthesis. Finally, these changes may be superimposed on a congenitally narrow canal.

The hallmark of lumbar stenosis is pain in the back and legs which is aggravated by standing and walking and relieved by sitting or forward bending. The syndrome of pain induced by walking is known as neurogenic claudication (from the Latin claudico, to limp). Neurogenic claudication must be distinguished from is vascular claudication, or leg pain on walking caused by insufficient blood flow to the legs. The features which help to distinguish neurogenic from vascular claudication are the following:

1. Pain occurs after varying amounts of exercise, with standing, or with coughing. Vascular claudication is reliably produced with a fixed amount of exercise, such as walking a certain number of blocks, and is rare at rest.
2. Pain relief with rest is variable and slow, usually requiring sitting or stooping. Resting in a standing position is usually not enough to relieve the pain and may even aggravate the pain. In contrast, the pain of vascular insufficiency is usually quickly relieved by resting in a standing position. This is the main distinguishing feature.
3. Pain from spinal stenosis is usually in a distribution of a spinal nerve rather than the muscles exercised.
4. Sensory loss is also in a nerve root distribution, while with vascular insufficiency it is in a stocking-glove distribution.
5. Signs of vascular insufficiency should be absent: diminished pulses, foot pallor on elevation, and decreased temperature of the feet.

Spondylolysis and Spondylolisthesis
The most common cause of low back pain in adolescent athletes is a stress fracture in one of the vertebrae that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects either the fourth or the fifth lumbar vertebra in the lower back. The fracture site is called a pars defect.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the top vertebrae can shift forward on top of the bottom vertebrae. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis).

In adults, a spondylolisthesis is usually caused from degenerative changes in the spine. If too much slippage occurs, the bones may begin to press on nerves and surgery may become necessary to correct the condition.

Causes

• Genetics: There may be an inherited aspect to spondylolysis. An individual may be born with a thin vertebral bone and therefore may be predisposed to this condition. Rapid growth spurts in a teen may also encourage slippage.
• Overuse: Several types of athletics, such as gymnastics, weight lifting and football, put a great deal of stress on the bones in the lower back. They also require that the individual constantly over-stretch (hyperextend) the spine. In either case, the excessive stress can lead to fractures of the vertebrae.
• Spondylolisthesis may also develop because of degenerative changes in the vertebral joints and certain medical conditions such as cerebral palsy.

Sacroiliac Joints
The sacroiliac joint connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). The joint:

1. Transmits all the forces of the upper body to the pelvis (hips) and legs
2. Acts as a shock-absorbing structure
3. Does not have much motion

The sacroiliac joint can become inflamed from an acute injury or from chronic postural abnormalities such as undue stress on the joint following low back fusion surgery. Pain from sacroiliac joint abnormalities can occur in the low back, buttock/hip, abdomen, groin, or legs.

Ankylosing Spondylitis
Ankylosing spondylitis primarily affects the spine or back. In a person with ankylosing spondylitis, the joints and ligaments that normally permit the spine to move become inflamed and stiff. The bones of the spine may grow together, causing the spine to become rigid and inflexible. Other joints such as the hips, shoulders, knees, or ankles also may become involved.

Other rare causes of back pain include:

• Benign or malignant tumors
• Infections
• Problems of the digestive tract or genitourinary tract
• Vascular problems such as an aneurysm or hardening of the arteries

Back & Neck Pain - Part I

Causes of back pain

Muscles/Ligaments

There are many causes of back pain, the most common of which is a sprain or strain of muscles or ligaments. Muscle spasm can occur after twisting or bending awkwardly, or from a simple sneeze or cough. The majority of muscle spasms tend to get better over time. Severe cases of muscle spasms are treated with medication, physical therapy, or injections.

Discs

Disc Degeneration
Disc problems are common causes of back pain. Discs are usually moist, like a sponge with water in it. After a disc injury, or as we age, discs lose water and deteriorate in a process called disc degeneration.

The earliest form of injury to a disc is in the form of tears or fissures in the annulus fibrosis (outer portion) of the disc. The annulus fibrosis is like a large round ligament that prevents the nucleus pulposus (inner portion) of the disc from pushing outward. Tears in the annulus heal by scar formation resulting in tissue that is not as strong as normal tissue. The repeated cycle of many annular tears healing by scar formation lead to a disc that begins to degenerate.

As a disc degenerates it becomes stiff, narrows, and losses it's ability to act as a shock absorber. Bone from the vertebrae above and below the disc may grow forming bone spurs. If bone spurs get large enough, they may cause pressure on nerves in the spinal canal, causing pain, numbness, and weakness in the arms or legs. The combination of disc degeneration and bone spur formation in the spine is called spondylosis. Any narrowing within the spinal canal, from bone spur formation or from any other cause is called spinal stenosis. Spondylosis or spinal stenosis can occur at any level in the spine-cervical, thoracic, or lumbar.

Bulging Disc, Protruding Disc, Herniated Disc, Extruded disc
Over time, because of injury or degeneration, discs start to change shape. Many terms describe this change in shape including bulging, protruding, herniated, prolapsed, slipped. They generally describe a disc that is displaced beyond the limits of the intervertebral disc space.

The earliest change in shape many times is in the form of a disc bulge-a wide based extension of the disc. Often, disc bulges do not cause pain. As the degenerative process progresses, the central, nucleus pulposus portion of the disc can extend through a tear in the outer annular wall of the disc, resulting in a focal protrusion or herniation of the disc. Disc protrusions can cause symptoms of pain, numbness, or weakness from nerve root pinching. In some individuals however, disc protrusions will not cause any symptoms. A disc extrusion is a severe version of a disc protrusion in which a large portion of the nucleus pulposus is displaced through the wall of the disc. A disc extrusion is almost always symptomatic.