Reading Your MRI Report: Bulging Discs vs. Herniated Discs

A bulging disc is generally the milder of the two conditions. It occurs when the intervertebral disc extends outward around its entire circumference, or at least more than 25% of the perimeter.

• Anatomy: The disc's tough outer wall (the annulus fibrosus) is stretched, weakened, and bulging, but it remains intact.
• Significance: It is often considered a normal sign of age-related wear (degenerative disc disease). It may be asymptomatic or cause symptoms only if the broad outward push irritates a nerve.

A herniated disc (sometimes called a "slipped disc") involves a tear or rupture in the outer wall of the disc.

• Anatomy: The inner, jelly-like material (nucleus pulposus) leaks out through the tear and directly into the spinal canal.
• Significance: Because the inner material is highly inflammatory, a herniation is more likely to cause acute, severe symptoms such as sharp, radiating pain (radiculopathy or sciatica) due to direct nerve root compression and chemical irritation.

Patient Success

Years of pain from a herniated disc relieved!

Disc herniations are further classified based on the shape of the displaced material. This information is critical for surgical planning.

• Disc protrusion (contained herniation):
  • Key MRI feature: The displaced material is focal (involving less than 25% of the circumference), and the base (the part touching the parent disc) is wider than the dome or tip of the material extending into the spinal canal.
  • Significance: Indicates a focal weakness or partial tear; the material is somewhat contained.
• Disc extrusion (non-contained herniation):
  • Key MRI feature: The displaced material has a narrower base at the site of exit than the material extending into the spinal canal. This often gives it a "mushroom" shape.
  • Significance: The inner material has broken through the entire outer disc wall. Extrusions are highly inflammatory and often require targeted pain management.
• Disc sequestration (free fragment):
  • Key MRI feature: A fragment of the extruded disc material has broken off completely from the parent disc and is now a "free fragment" floating in the spinal canal.
  • Significance: These fragments can cause multi-level compression but sometimes have a higher chance of being reabsorbed by the body's immune system over time. Monitoring a free fragment often involves repeat MRIs to track its size and location.

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The radiologist will specifically note whether the disc material is touching, displacing, or compressing a nerve root. This finding confirms the source of your radiating symptoms.

• Grading compression: Reports often use terms like "mild effacement," "moderate compression," or "severe displacement" to grade the severity of nerve root involvement. A severe compression is a key indicator for advanced non-invasive or surgical treatment consideration.
• Common site: The L5-S1 disc is the most frequently affected level, often compressing the S1 nerve root, which causes classic sciatica symptoms down the back of the leg and into the foot.

A large disc abnormality, often combined with age-related changes like bone spurs, can narrow the space available for the spinal cord or nerve roots.

• Central canal stenosis: Narrowing of the main spinal canal, which can impact the spinal cord itself.
• Foraminal stenosis: Narrowing of the small opening (foramen) where the nerve root exits the spine.

Measuring the stenosis: The MRI allows providers to accurately measure the remaining cross-sectional area of the spinal canal. This measurement helps determine the functional impact of the disc on the patient's mobility, especially when standing or walking, and guides the treatment plan toward decompression if necessary.

• Epidural steroid injections (ESIs): The MRI is absolutely vital for ESIs. The image allows the physician to identify the exact nerve root being compressed (e.g., the right L5 nerve root) and the safest approach for delivering the anti-inflammatory medication directly to the inflamed area under X-ray guidance (fluoroscopy).
• Physical therapy (PT): The MRI helps guide the physical therapist, indicating which movements (e.g., specific spinal flexion or extension) should be avoided or emphasized to prevent further irritation of the injured disc.
• Spinal decompression therapy: This non-invasive treatment is most effective for certain types of bulging discs and contained protrusions, as it gently creates negative pressure within the disc space to promote retraction.

For most patients, non-surgical treatment resolves symptoms. Surgery is reserved for cases where:

1. Non-operative care fails: Persistent, debilitating pain lasts for 6 weeks or more despite consistent, appropriate conservative treatment.
2. Progressive neurological deficits: The patient experiences worsening weakness (e.g., foot drop) or loss of bowel/bladder function (Cauda Equina Syndrome—an emergency).

Herniated and Bulging Disc Treatment

Learn how Dr. Deukmedjian cures herniated and bulging discs at the Deuk Spine Institute.

Minimally invasive microdiscectomy: This surgery is common for symptomatic herniated discs (protrusions or extrusions). It involves a small incision to remove only the part of the disc compressing the nerve. The surgeon relies entirely on the MRI to confirm the affected level and the side of the compression before planning the procedure, ensuring precision and high success rates.

Deuk Laser Disc Repair®: A Minimally Invasive Alternative

Traditional surgeries for herniated and bulging discs, such as standard microdiscectomy, involve removing the disc fragment causing compression. However, advanced options like Deuk Laser Disc Repair® (DLDR) and Deuk Plasma Rhizotomy® (DPR) offer a highly precise, minimally invasive alternative.

The procedure is designed to treat both bulging and herniated discs by:

• Precision targeting: Utilizing the MRI findings to guide the surgery, the surgeon precisely accesses the disc through a small incision.
• Removing damaged tissue: A state-of-the-art laser is used to vaporize the painful disc material—the bulge or herniation—without damaging the surrounding bone, nerves, or healthy disc tissue.
• Sealing the annulus: Unlike traditional procedures that may leave the tear open, this technique focuses on repairing and sealing the annular tear, which is often the source of chronic pain and prevents the nucleus pulposus from leaking again.

A: No. A broad-based disc bulge is distinct from a herniated disc. A bulge means the outer disc wall is weakened and stretched but still intact, extending broadly around the disc's circumference. A herniated disc involves a definite tear or rupture in the outer wall, allowing the inner material to displace focally into the spinal canal. While both can cause symptoms, the herniation is generally considered more anatomically severe.

A: Not necessarily. An annular tear (or annular fissure) is a tear in the outer disc wall (annulus fibrosus). It is visible on an MRI and can cause localized back pain, sometimes noted as a "High-Intensity Zone" (HIZ). A herniated disc occurs only if that tear is large enough to allow the inner disc material to push out (protrusion) or leak out (extrusion). A tear can exist without an accompanying mass that compresses a nerve.

A: The L5-S1 disc, located at the very bottom of the lumbar spine where the spine connects to the sacrum, is the most frequently affected level for several reasons. It carries the highest load of the body's weight and is subject to the most shear force during bending, twisting, and lifting. This mechanical stress makes it highly susceptible to degenerative changes, disc flattening, and subsequent herniation.