Lumbar Disc Central Extrusion

Lumbar disc central extrusion refers to a form of herniation where the nucleus pulposus breaches the annulus fibrosus and extends centrally into the spinal canal, often compressing neural elements. Unlike protrusions, in which the base of herniated material is wider than its outward extension, extrusion is defined by herniated material whose maximum distance from the disc space exceeds the width of its connection to the parent disc—signifying a noncontained lesion with a greater risk of neural compression RadiopaediaRadiology Assistant.

Lumbar disc central extrusion, a form of herniated disc, occurs when the soft inner core (nucleus pulposus) of a lumbar intervertebral disc pushes through the outer layer (annulus fibrosus) toward the center of the spinal canal. This can compress spinal nerves and cause pain, numbness, or weakness in the lower back and legs. Understanding its anatomy, treatment options, and preventive strategies can help patients manage symptoms effectively and improve long-term spinal health.

Lumbar disc central extrusion is a specific type of intervertebral disc herniation in which the nucleus pulposus breaches the annulus fibrosus and extends centrally into the spinal canal, often with a dome that is larger than its neck and with loss of continuity with the parent disc in sequestration casesRadiopaediaRadiopaedia. This extrusion can compress neural structures—particularly the cauda equina in central canal cases—leading to characteristic clinical syndromes.

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Anatomy of the Lumbar Intervertebral Disc

Structure and Location

The lumbar intervertebral disc is a fibrocartilaginous structure situated between adjacent lumbar vertebral bodies (L1–L5). It comprises two main components: the annulus fibrosus, a tough, multilamellar ring of collagen fibers, and the nucleus pulposus, a gelatinous core rich in proteoglycans that provides compressibility and shock absorption. The disc occupies the intervertebral space, contributing to approximately one quarter of the spine’s length and delineating the functional spinal unitWikipediaNCBI.

Origin and Insertion

Unlike muscles, the disc does not “originate” or “insert” in the classical sense; rather, its outer fibers firmly attach to the superior and inferior vertebral endplates. The annulus fibrosus inserts into the bony margins of the vertebral bodies via Sharpey’s fibers, ensuring a firm mechanical linkage that resists shear and torsional stresses across the motion segmentWikipediaAnatomy.

Blood Supply

In postnatal life, the intervertebral disc is essentially avascular. During embryonic development, small capillaries penetrate the outer annulus fibrosus and endplates, but these vessels regress by early childhood. In adults, nutrients and oxygen diffuse through the cartilaginous endplates and outer annulus via osmosis and imbibition, which makes the disc especially vulnerable to degenerative changes when endplate permeability is reducedKenhubKenhub.

Nerve Supply

Sensory innervation is limited to the outer third of the annulus fibrosus, primarily via the sinuvertebral (recurrent meningeal) nerves and branches of the gray rami communicantes. In degenerative states, nociceptive fibers may grow into deeper layers of the annulus and even reach the nucleus pulposus, contributing to discogenic painRadiopaediaWheeless’ Textbook of Orthopaedics.

Functions

The lumbar intervertebral disc serves six key functions:

1. Shock Absorption: The nucleus pulposus distributes compressive loads evenly across the vertebral endplates.

2. Load Transmission: It transmits axial loads from one vertebra to the next, facilitating weight-bearing.

3. Mobility: The disc permits flexion, extension, lateral bending, and limited rotation of the spinal segment.

4. Stability: Along with ligaments and facet joints, it stabilizes the spine against shear forces.

5. Spacing: Maintains intervertebral height, ensuring appropriate foraminal dimensions for nerve roots.

6. Ligamentous Function: Acts as a symphysis joint, holding vertebrae together while allowing motionWikipediaNCBI.

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Types of Lumbar Disc Extrusion

Intervertebral disc herniations are classified by shape and displacement of disc material: bulge, protrusion, extrusion, and sequestration. Within extrusions, location-based subtypes include:

• Central Extrusion: Bulging directly into the central canal.

• Paracentral Extrusion: Just lateral to midline, often compressing traversing nerve roots.

• Foraminal (Lateral) Extrusion: Into the neural foramen, impinging exiting nerve roots.

• Extraforaminal (Far Lateral) Extrusion: Beyond the foramen, affecting the exiting root more distally.

Each subtype has distinct clinical correlations; central extrusions most commonly risk cauda equina compromiseRadiopaediaRadiopaedia.

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Causes of Lumbar Disc Central Extrusion

Age-Related and Degenerative Factors

• Disc Degeneration from proteoglycan loss reduces disc height and resilience.

• Annular Tears in the fibrous rings allow nucleus pulposus to herniate.

• Cumulative Microtrauma from daily activities weakens the annulus.

• Nutritional Deficits due to impaired endplate diffusion compromise matrix repair.

• Dehydration of Nucleus Pulposus lowers intradiscal pressure and stabilityWikipediaNCBI.

 Mechanical and Lifestyle Factors

• Heavy Lifting with poor technique increases intradiscal pressure.

• Repetitive Flexion/Extension motions in occupational tasks.

• Torsional Stresses during twisting activities.

• Obesity elevates axial loads on the lumbar spine.

• Smoking impairs disc nutrition and accelerates degenerationWikipediaRadiopaedia.

 Anatomical and Postural Influences

• Genetic Predisposition to weaker annular collagen structure.

• Lumbar Hyperlordosis concentrating stresses on posterior annulus.

• Poor Posture during sitting and standing exacerbates disc strain.

• Vibration Exposure (e.g., heavy machinery operators).

• Facet Joint Osteoarthritis altering load distribution to discsWikipediaRadiopaedia.

Other Contributing Factors

• Endplate Sclerosis reducing nutrient passage.

• Metabolic Disorders (e.g., diabetes) impairing tissue repair.

• Spinal Instability or Spondylolisthesis increasing abnormal motion.

• Previous Lumbar Surgery causing altered biomechanics.

• Congenital Disc Anomalies such as Schmorl’s nodesWikipediaNCBI.

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Symptoms of Lumbar Disc Central Extrusion

Local Pain and Stiffness

• Axial Low Back Pain aggravated by flexion.

• Morning Stiffness due to overnight disc hydration.

• Improvement with Movement as nucleus redistributes.

• Pain on Prolonged Sitting increasing intradiscal pressure.

• Paraspinal Muscle Spasm protective guardingRadiopaediaRadiopaedia.

Radicular Symptoms

• Bilateral Leg Pain or Paresthesia if central canal compromise.

• Neurogenic Claudication on walking or standing.

• Sensory Loss in dermatomal distribution.

• Motor Weakness of distal lower limb muscles.

• Reflex Changes (e.g., diminished patellar or Achilles reflex)RadiopaediaRadiopaedia.

Neurogenic Signs of Cauda Equina Syndrome

• Saddle Anesthesia in perianal region.

• Bladder Dysfunction (urinary retention or incontinence).

• Bowel Dysfunction (fecal incontinence).

• Sexual Dysfunction (erectile difficulties).

• Loss of Anal Wink ReflexRadiopaediaRadiopaedia.

Aggravating and Relieving Factors

• Worse with Forward Flexion and Coughing/Sneezing due to increased canal pressure.

• Relief When Supine with knees flexed (decreases intradiscal pressure).

• Night Pain that may disturb sleep.

• Response to NSAIDs mild-to-moderate relief.

• Poor Response to Conservative Measures suggests large central extrusionRadiopaediaRadiopaedia.

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Diagnostic Tests for Lumbar Disc Central Extrusion

Physical Examination

1. Observation: Postural abnormalities and antalgic gait.

2. Palpation: Tenderness over spinous processes and paraspinal muscles.

3. Range of Motion: Flexion-extension testing for pain reproduction.

4. Straight Leg Raise (SLR): Pain between 30–70° suggests nerve root tension.

5. Crossed SLR: Contralateral leg raising reproducing ipsilateral pain.

6. Gait and Station: Assess neurogenic claudicationRadiopaediaRadiopaedia.

Manual (Provocative) Tests

1. Femoral Nerve Stretch Test: Extension of hip with knee flexed.

2. Slump Test: Seated slouched posture with cervical flexion.

3. Quadrant (Kempe’s) Test: Back extension, lateral bend, rotation.

4. Milgram’s Test: Sustained bilateral hip flexion.

5. Vaspring Test: Posterior-to-anterior pressure over spinous processes.

6. Goldthwait’s Test: Separate lumbar from sacroiliac involvementRadiopaediaRadiopaedia.

Laboratory and Pathological Tests

1. Complete Blood Count (CBC): Rule out infection.

2. Erythrocyte Sedimentation Rate (ESR)/CRP: Inflammation or discitis.

3. HLA-B27 Testing: Associated spondyloarthropathies.

4. Serum Glucose and Lipid Profile: Metabolic contributors.

5. Disc Biopsy: Rarely indicated for suspected infection/malignancy.

6. Autoimmune Panels: If systemic arthropathy suspectedNCBINCBI.

Electrodiagnostic Tests

1. Nerve Conduction Studies (NCS): Assess peripheral nerve integrity.

2. Electromyography (EMG): Detect denervation of paraspinal and limb muscles.

3. Somatosensory Evoked Potentials (SSEP): Central pathway conduction.

4. Motor Evoked Potentials (MEP): Corticospinal tract evaluation.

5. F-wave Studies: Proximal nerve root status.

6. H-reflex: S1 nerve root functionRadiopaediaScienceDirect.

Imaging Tests

1. X-Ray (Plain Films): Rule out fractures, alignment, Modic changes.

2. Magnetic Resonance Imaging (MRI): Gold standard for extrusion visualization.

3. Computed Tomography (CT): Bone detail and extruded fragment calcification.

4. CT Myelography: Alternative when MRI contraindicated.

5. Ultrasound: Limited use; guided injections.

6. Discography: Provocative; reserved for surgical planningRadiopaediaRadiopaedia.

Non-Pharmacological Treatments

A. Physiotherapy & Electrotherapy

1. Manual Mobilization

   • Description: Therapist-guided gentle movements of the spine.

   • Purpose: Improve vertebral alignment and reduce nerve pressure.

   • Mechanism: Loosens joints, decreases muscle guarding, enhances spinal glide.

2. Spinal Manipulation

   • Description: High-velocity, low-amplitude thrusts applied by a chiropractor or physiotherapist.

   • Purpose: Provide pain relief and restore range of motion.

   • Mechanism: Releases joint adhesions, stimulates mechanoreceptors to modulate pain.

3. Transcutaneous Electrical Nerve Stimulation (TENS)

   • Description: Low-voltage electrical currents via skin electrodes.

   • Purpose: Alleviate pain and muscle spasm.

   • Mechanism: Activates large nerve fibers to inhibit pain signal transmission.

4. Interferential Current Therapy

   • Description: Two medium-frequency currents crossing at the painful area.

   • Purpose: Reduce inflammation and pain.

   • Mechanism: Deeper tissue penetration, increased blood flow, and endorphin release.

5. Ultrasound Therapy

   • Description: Sound waves delivered via a transducer.

   • Purpose: Promote tissue healing and reduce inflammation.

   • Mechanism: Thermal and non-thermal effects enhance cell repair.

6. Heat Therapy (Moist Heat Packs)

   • Description: Warm compresses applied to the lower back.

   • Purpose: Relieve muscle spasm and stiffness.

   • Mechanism: Increases circulation, relaxes tight muscles.

7. Cold Therapy (Cryotherapy)

   • Description: Ice packs applied for short intervals.

   • Purpose: Reduce acute inflammation and numb pain.

   • Mechanism: Vasoconstriction limits swelling, slows nerve conduction.

8. Traction Therapy

   • Description: Mechanical or manual pulling of the spine.

   • Purpose: Decompress herniated disc material.

   • Mechanism: Gently separates vertebrae, relieving nerve root pressure.

9. Laser Therapy

   • Description: Low-level laser light applied to tissues.

   • Purpose: Enhance healing and reduce pain.

   • Mechanism: Photobiomodulation stimulates mitochondria, boosting cell repair.

10. Kinesiology Taping

    • Description: Elastic tape applied along paraspinal muscles.

    • Purpose: Support muscles, improve posture.

    • Mechanism: Lifts skin to reduce pressure and promote lymphatic flow.

11. Soft Tissue Massage

    • Description: Hands-on kneading of back muscles.

    • Purpose: Relieve muscle tension.

    • Mechanism: Breaks down adhesions, increases blood flow.

12. Myofascial Release

    • Description: Sustained pressure on fascial restrictions.

    • Purpose: Improve tissue mobility.

    • Mechanism: Lengthens fascia, decreases pain receptors’ sensitivity.

13. Dry Needling

    • Description: Fine needles into trigger points of back muscles.

    • Purpose: Alleviate muscle knots and pain.

    • Mechanism: Disrupts dysfunctional motor endplates, reduces local inflammation.

14. Biofeedback Training

    • Description: Real-time monitoring of muscle activity.

    • Purpose: Teach relaxation and muscle control.

    • Mechanism: Visual/auditory feedback helps patients reduce spasm.

15. Postural Education

    • Description: Guidance on proper sitting, standing, and lifting.

    • Purpose: Prevent aggravation of the extruded disc.

    • Mechanism: Encourages neutral spine alignment to minimize stress.

B. Exercise Therapies

1. McKenzie Extension Exercises

   • Description: Repeated back extensions lying prone or standing.

   • Purpose: Centralize pain toward the spine.

   • Mechanism: Applies posterior pressure to relocate nucleus pulposus.

2. Core Stabilization

   • Description: Pilates-style exercises focusing on deep trunk muscles.

   • Purpose: Support lumbar spine and reduce load on discs.

   • Mechanism: Strengthens transverse abdominis and multifidus muscles.

3. Flexion-Based Stretches

   • Description: Knees-to-chest and pelvic tilts exercises.

   • Purpose: Open posterior disc space in select patients.

   • Mechanism: Reduces nerve root compression via flexion posture.

4. Hamstring Stretching

   • Description: Static stretches of the back of the thigh.

   • Purpose: Decrease tensile forces on the lumbar region.

   • Mechanism: Elongates hamstrings, reducing pelvic tilt.

5. Quadratus Lumborum Release

   • Description: Lateral trunk bends and targeted stretches.

   • Purpose: Relieve side-back muscle tightness.

   • Mechanism: Lengthens QL, easing asymmetric spinal load.

6. Glute Bridge

   • Description: Lying supine, lifting hips off the floor.

   • Purpose: Strengthen gluteal and posterior chain muscles.

   • Mechanism: Activates hip extensors to support lower back.

7. Bird-Dog

   • Description: On hands and knees, extending opposite arm and leg.

   • Purpose: Improve spinal stability and coordination.

   • Mechanism: Engages core and back extensors in a neutral spine.

8. Low-Impact Aerobic Exercise

   • Description: Walking, stationary cycling, or swimming.

   • Purpose: Enhance circulation and overall fitness.

   • Mechanism: Promotes endorphin release, reduces muscle guarding.

C. Mind-Body Therapies

1. Yoga (Gentle Styles)

   • Description: Poses emphasizing core strength and flexibility.

   • Purpose: Improve body awareness and reduce pain.

   • Mechanism: Combines stretching with breath control to relax muscles.

2. Tai Chi

   • Description: Slow, flowing movements with focused breathing.

   • Purpose: Enhance balance and reduce stress.

   • Mechanism: Gentle weight shifts relieve spinal load, lower cortisol.

3. Meditation/Mindfulness

   • Description: Guided or silent focus on breath and body sensations.

   • Purpose: Modulate pain perception and stress response.

   • Mechanism: Activates parasympathetic nervous system, lowers pain sensitivity.

4. Cognitive Behavioral Therapy (CBT)

   • Description: Talking therapy to change pain-related thoughts.

   • Purpose: Improve coping strategies and decrease disability.

   • Mechanism: Reframes negative beliefs, reducing fear-avoidance behaviors.

D. Educational Self-Management

1. Back Care Workshops

   • Description: Group classes on ergonomics and safe movement.

   • Purpose: Empower patients to manage flare-ups.

   • Mechanism: Knowledge transfer fosters proactive behavior.

2. Pain Neuroscience Education

   • Description: Explaining how pain signals are processed.

   • Purpose: Reduce fear and improve activity tolerance.

   • Mechanism: Alters pain perception through central modulation.

3. Home Exercise Programs

   • Description: Customized routines prescribed by therapists.

   • Purpose: Maintain gains from clinical sessions.

   • Mechanism: Regular practice strengthens supporting muscles.

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Pharmacological Treatments

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Dietary Molecular Supplements

1. Glucosamine Sulfate

   • Dosage: 1500 mg daily

   • Function: Supports cartilage health

   • Mechanism: Provides substrate for glycosaminoglycan synthesis, improving disc matrix integrity.

2. Chondroitin Sulfate

   • Dosage: 800–1200 mg daily

   • Function: Reduces inflammation

   • Mechanism: Inhibits degradative enzymes in cartilage and disc tissue.

3. Omega-3 Fish Oil

   • Dosage: 1000–2000 mg EPA/DHA daily

   • Function: Anti-inflammatory

   • Mechanism: Competes with arachidonic acid, reducing pro-inflammatory eicosanoids.

4. Curcumin (Turmeric Extract)

   • Dosage: 500–1000 mg twice daily (standardized)

   • Function: Modulates inflammatory pathways

   • Mechanism: Inhibits NF-κB signaling, lowering cytokine production.

5. MSM (Methylsulfonylmethane)

   • Dosage: 1000–3000 mg daily

   • Function: Joint and connective tissue support

   • Mechanism: Provides sulfur for collagen and antioxidant glutathione synthesis.

6. Vitamin D₃

   • Dosage: 1000–2000 IU daily

   • Function: Bone health and immune modulation

   • Mechanism: Enhances calcium absorption, modulates inflammatory responses.

7. Magnesium

   • Dosage: 300–400 mg daily

   • Function: Muscle relaxation and nerve function

   • Mechanism: Regulates calcium transport in muscle cells, reducing spasm.

8. Collagen Hydrolysate

   • Dosage: 10 g daily

   • Function: Supports disc matrix repair

   • Mechanism: Supplies amino acids (glycine, proline) for collagen synthesis.

9. Boswellia Serrata Extract

   • Dosage: 300–500 mg thrice daily

   • Function: Anti-inflammatory

   • Mechanism: Inhibits 5-lipoxygenase, reducing leukotriene-mediated inflammation.

10. Resveratrol

    • Dosage: 150–500 mg daily

    • Function: Antioxidant and anti-inflammatory

    • Mechanism: Activates SIRT1, suppresses inflammatory gene expression.

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Advanced Drug Therapies

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Surgical Options

1. Microdiscectomy

   • Procedure: Removal of herniated disc fragment via small incision and microscope.

   • Benefits: Rapid pain relief, minimal tissue damage.

2. Laminectomy

   • Procedure: Removal of part of vertebral bone (lamina) to decompress nerves.

   • Benefits: Reduces nerve compression, improves mobility.

3. Endoscopic Discectomy

   • Procedure: Herniated material removed using endoscope and small port.

   • Benefits: Less invasive, shorter recovery.

4. Disc Replacement (Arthroplasty)

   • Procedure: Damaged disc replaced with an artificial one.

   • Benefits: Maintains motion, reduces adjacent-level stress.

5. Spinal Fusion

   • Procedure: Two vertebrae permanently joined using bone graft and implants.

   • Benefits: Stabilizes spine, prevents further slippage.

6. Foraminotomy

   • Procedure: Enlargement of nerve root openings (foramina).

   • Benefits: Relieves nerve impingement without full disc removal.

7. Interspinous Process Spacer

   • Procedure: Implant inserted between spinous processes to limit extension.

   • Benefits: Minimally invasive, preserves motion.

8. Percutaneous Discectomy

   • Procedure: Tiny needle removes disc material under imaging guidance.

   • Benefits: Outpatient, minimal muscle disruption.

9. Dynamic Stabilization

   • Procedure: Flexible devices anchored to vertebrae to support movement.

   • Benefits: Stabilizes while allowing controlled motion.

10. Transforaminal Lumbar Interbody Fusion (TLIF)

    • Procedure: Fusion from a lateral approach, cage insertion.

    • Benefits: High fusion rates, indirect nerve decompression.

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Prevention Strategies

1. Maintain a Healthy Weight

2. Practice Proper Lifting Techniques

3. Strengthen Core Muscles Regularly

4. Use Ergonomic Chairs & Workstations

5. Avoid Prolonged Sitting—Take Frequent Breaks

6. Perform Daily Stretching Routines

7. Wear Supportive Footwear

8. Quit Smoking (Improves Disc Nutrition)

9. Stay Hydrated (Disc dehydration prevention)

10. Incorporate Low-Impact Exercise into Routine

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When to See a Doctor

Seek medical attention if you experience:

• Severe, worsening back pain that does not improve with rest or home care.

• Leg weakness or numbness, especially if it affects your ability to walk or stand.

• Bowel or bladder changes, such as incontinence or retention—this may indicate spinal cord involvement (cauda equina syndrome).

• High fever with back pain, which could suggest infection.

• Unexplained weight loss accompanied by back pain, a possible sign of serious pathology.

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What To Do and What To Avoid

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Frequently Asked Questions (FAQs)

1. What exactly is central disc extrusion?
   Central disc extrusion happens when the soft inner gel of a lumbar disc ruptures through its outer layer and pushes directly into the spinal canal, pressing on nerves.

2. How does it differ from a bulging disc?
   A bulging disc bulges outward without tearing its outer layer; an extrusion involves a tear and displacement of inner material.

3. What causes central extrusion?
   Common causes include age-related wear, sudden heavy lifting with poor form, and repetitive strain injuries.

4. Can it heal on its own?
   Mild cases may shrink and improve with conservative care over weeks to months, as the body reabsorbs some disc material.

5. Is surgery always necessary?
   No. Over 80 % of patients improve with non-surgical treatments; surgery is reserved for severe pain, neurological deficits, or cauda equina signs.

6. How long does recovery take?
   With conservative care, many see relief in 6–12 weeks. Post-surgery, most return to normal activities within 6–12 weeks as well.

7. Will it recur?
   Some patients may experience recurrence, especially without proper core strengthening and lifestyle adjustments.

8. Are there long-term complications?
   Rarely, chronic nerve damage can cause persistent numbness or weakness if untreated for months.

9. Can I exercise with a disc extrusion?
   Yes—low-impact exercises prescribed by a professional can aid healing and prevent stiffness.

10. Does weight loss help?
    Losing excess weight reduces spinal load and decreases risk of further disc injury.

11. Is massage safe?
    Gentle, professional massage can relieve muscle tension; avoid deep pressure directly over the herniation.

12. What pain medications are best?
    NSAIDs like ibuprofen often work first; if pain persists, your doctor may add neuropathic agents or muscle relaxants.

13. Can injection therapies help?
    Epidural steroid injections can reduce local inflammation and provide temporary relief.

14. Will physical therapy make it worse?
    When guided by trained therapists using safe techniques, physical therapy is beneficial and rarely harmful.

15. How do I prevent future disc problems?
    Maintain core strength, practice good posture, lift safely, and stay active with low-impact exercises.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 18, 2025.

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