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How to Read the MRI for a Herniated Disc and 5 Treatment Options

Author:  
Dr. Deuk
An expert in all things spine, Dr. Deukmedjain is a board certified neurosurgeon who has performed thousands of minimally invasive surgeries and procedures including the revolutionary Deuk Laser Disc Repair and the Deuk Spinal Fusion. 

Magnetic Resonance Imaging (MRI) machines have been one of the most important inventions in modern medicine. With MRI, surgeons can accurately evaluate and diagnose spinal conditions, including herniated discs.

A herniated disc MRI is a critical medical diagnostic tool that allows healthcare professionals to visualize the condition of the spinal discs and surrounding areas with exceptional clarity.

This article contains everything you need to know about herniated disc MRI, including how to read the MRI for a herniated disc and the treatment options. 

What is an MRI for a Herniated Disc?

Herniated discs MRI scans are a helpful test used to determine the exact location and condition of the problem. Patients who complain of experiencing symptoms related to herniated discs are often advised to get an MRI scan done first.

An MRI scan is the best non-invasive test available to find herniated and bulging discs and annular tears

CT scans use harmful X-rays and have far less accuracy because of factors that reduce the visibility of the soft tissue structural changes seen with a herniated disc. CT scans are best for looking at spinal alignment and bony issues as seen with spine fractures. MRI scans provide highly accurate representations of spinal discs and problems going on in and around the discs such as inflammation and degeneration. MRI is considered the gold standard in medicine for evaluating disc injuries.

Think you have a herniated disc? Get a free MRI review from Deuk Spine Institute

When would you need an MRI for a herniated disc? 

Here are some common reasons for a herniated disc MRI scan:

Confirming suspicion of a herniated disc: If your doctor suspects a herniated disc based on your symptoms and physical exam, they may order an MRI to confirm the diagnosis. MRIs provide detailed images of the spine’s soft tissues, including discs, which help pinpoint the location and severity of the herniation.

Ruling out other causes of pain:  While back pain is a common symptom of herniated discs, it can also be caused by other conditions like spinal stenosis, tumors, or infections. An MRI can help distinguish between these possibilities.

Planning surgery: If surgery is deemed necessary to address the herniated disc, an MRI will provide detailed anatomical information to assist the surgeon in planning the approach.

What Does a Herniated Disc Look Like on an MRI?

On an MRI, a herniated disc typically appears as a bulge or protrusion from the disc’s normal boundary, indicating where the disc material has extended beyond its usual confines.

herniated-disc-mri

Disc protrusion on an MRI

Source

How to Read an MRI for a Herniated Disc

The interpretation of an MRI scan depends on several factors. Like several other diagnostic tests, the challenge with MRI scan results is that the “disorder” that appears on the scan is not always the origin of backaches.

To accurately read a lumbar MRI scan for a herniated disc, patients must possess a basic understanding of the anatomical structure of the lumbar spine. There are 5 vertebrae components in the lower back and they are separated by two types of joints including facets and discs. 

In most cases, these discs are subjected to constant motion causing wear and tear. When the outer layer of the disc is ruptured, called an annular tear, its inner nucleus jelly squeezes out into the spinal canal and forms a hernia. This hernia will often show up as a contrasting spot in an MRI scan.

As a general rule of thumb, MRI scan results are interpreted by the physiological symptoms exhibited and experienced by the patient. On its own, a herniated disc might not produce any symptoms in the patient; therefore, many individuals live with undiagnosed back conditions. 

However, when the herniated disc becomes bulged or protruded, it can begin to cause severe pain. An excellent video explaining how spinal disc herniations cause back pain can be found here

What Your Doctor Might Do When Reading a Herniated Disc MRI

After your doctor orders your MRI, the technician conducting your MRI will place you in a tube-like device. The device then rotates a magnet around a patient’s body, changing the level of excitation of hydrogen atoms within tissues in the patient’s body. 

Once the magnetic field is removed, the hydrogen atoms return to their usual resonance state and they release a small quantity of energy which the scanner may detect to produce the image known as the MRI scan. 

The generated MRI scan image depicts anatomy by distinguishing between tissues with a lot of water (such as cerebrospinal fluid or discs) and tissues with little water (such as skin, bone, cartilage, and nerve roots). 

Once this image is produced, your doctor will examine it for any anomalies to diagnose your condition. MRI scans are particularly sensitive for detecting disc injuries such as lumbar disc herniations, bulging discs, annular tears that cause back discomfort, or even pinched nerves.

What is a Herniated Disc?

There are 23 intervertebral discs located within the spinal column, segmented into 6 cervical, 12 thoracic, and 5 lumbar discs. These discs function as soft tissue joints, consisting of a nucleus pulposus—a hydraulic, gelatinous core—surrounded by a sturdy, outer collagen layer known as the annulus fibrosus. 

Their primary role is to cushion the spinal vertebrae and nerves against abrupt impacts, absorbing shocks from spinal movements such as bending, twisting, and jumping. However, the disc’s external layer, the annulus fibrosus, is susceptible to traumatic injuries (annular tears), leading to the nucleus pulposus protruding backward through these tears into the spinal canal or neural foramen.

The segment of the nucleus pulposus that extrudes through the tear is referred to as the herniation. Often, this herniated portion can compress a nerve, causing inflammation and irritation in the affected nerve.

Herniated Disc Causes 

A herniated disc can occur for a variety of causes. Trauma from injury or wear and tear are the most common. The cartilage that joins the discs in the spine to the corresponding vertebral member can become loose and lose elasticity as people get older. 

Sudden impact and trauma, such as accidents or falls, can also cause herniated discs.

Risk Factors for Disc Herniation

Several risk factors can increase the likelihood of experiencing a disc herniation:

  1. Age: Disc herniation is most common in middle-aged adults, typically between the ages of 30 and 50. This is due to the natural aging process, during which intervertebral discs lose their water content and elasticity, making them more susceptible to tearing.
  2. Gender: Men are more likely to experience disc herniations than women, particularly in the younger age group.
  3. Occupation and Physical Activity: Jobs or activities that involve heavy lifting, pulling, bending, or twisting—especially when combined with vibration (such as driving heavy vehicles) can place additional stress on the spine and increase the risk of disc herniation.
  4. Weight: Excessive body weight increases the load on the discs in the lower back, leading to a higher risk of herniation.
  5. Smoking: Smoking can reduce the oxygen supply to the disc, accelerating the degeneration process and making smokers more susceptible to herniation.
  6. Sedentary Lifestyle: Lack of regular exercise can lead to weak back muscles, reducing support for the spine and potentially increasing the risk of disc problems.
  7. Genetics: A family history of disc herniation or other disc diseases can increase an individual’s risk, suggesting a genetic predisposition.
  8. Posture: Poor posture can contribute to the development of disc herniation by increasing stress on the spine.

Herniated Disc Symptoms

Nerve Irritation

The most common way herniated discs cause symptoms is by irritating nearby nerves. The interaction between the nucleus pulposus and the small blood vessels within the outer half of the annulus fibrosus causes a severe inflammatory response within the annular tear. 

When the inflammation occurs in the back of the disc where a certain type of pain nerve fiber is present, pain signals travel via somatic afferent (SA) sensory nerves to parts of the brain responsible for localizing the pain. The somatic afferent (SA) fibers end up synapsing on neurons within the post-central gyrus, an area of the brain known as the primary somatosensory cortex

This area of the brain gives pain signals from all over the body their location tag and associated qualities like “sharpness” and “stabbing.”  It’s only because the posterior annulus is innervated by SA pain fibers that we can easily identify disc pain location and quality from a herniated disc. 

Localized Pain Over the Painful Inflamed Disc

Another common symptom of a herniated disc is sharp pain localized directly over the painful inflamed disc(s). The inflammation from the disc herniation can spread to the dural covering around nerves and spinal cord causing nerve irritation and even headaches. Headaches originating in the neck and moving upwards to the back of the skull are called “cervicogenic” headaches. When the disc is repaired properly, such as with the Deuk Laser Disc Repair technique, the headaches go away permanently.

When inflammation from the herniated disc spreads to the nearby covering around nerve roots, painful sensations can travel down arms (cervical herniations) or legs (lumbar herniations or even around the ribs (thoracic herniations). 

Nerve Root Dermatome

The nerve root dermatome is one of the most prevalent areas to see signs and symptoms of a herniated disc. A loss of normal sensation in the arms, elbows, and shoulder is one example. Cervical radiculopathy is the medical word for this condition, which is characterized by radicular discomfort in this location and the appearance of a hot sensation radiating outwards from the source of pain. 

The nerve root myotome, which is the muscles in the arm or leg regulated by the nerve root, is likely to be affected by disc herniation. This frequently causes weakness in the muscles in this area, particularly the triceps, shoulders, legs, and upper arm in general. These anatomical parts may also be difficult to move for the patient. 

Treatment Options for a Herniated Disc 

Below we have highlighted seven of the best surgical treatments available for herniated discs;

1. Deuk Laser Disc Repair for Herniated Discs

The Deuk Laser Disc Repair treatment is a minimally invasive procedure. The surgeon utilizes an endoscope (a small tube with a light and camera attached) to reach the source of back discomfort without removing any supporting joints, bones, or ligaments by passing through a natural small opening in the spine called the neural-foramen. 

This surgery is a revolutionary, outpatient, all-natural procedure that has been proven to cure back pain or neck pain from herniated discs. This surgery is proven to be safe and effective using only FDA-approved technology.

The surgeon uses a narrow endoscope to visualize the injured disc and then uses a precision laser to remove only the damaged disc tissue that is causing the pain. Because the injured tissue accounts for only 5 to 10% of the total disc tissue, the precision laser will not affect the surrounding bone and tissues, preserving the healthy disc.

Bulging discs, sciatica, spinal stenosis, pinched nerves, herniated discs, and other disorders that cause significant, chronic pain can all be treated successfully with Deuk Laser Disc Repair. 

There is no need for a hospital stay, narcotic painkillers, or opioids with this treatment. Patients can leave the clinic an hour after surgery with only a 1/4-inch incision and a bandaid. In over 2,000 procedures, there has been a 99.6% success rate, with every patient returning safely home. While complication rate for lower back and basic spine surgery is between 5-59% (for Deuk Laser Disc Repair, it is 0%).

2. Spinal Fusion Surgery / Spinal Arthrodesis 

The surgeon permanently unites or fuses two or more vertebrae during any spinal fusion operation. These vertebrae fuse together to form a single solid, long bone but natural movement is lost forever. This surgical procedure was developed to replicate the natural mending process of fractured bones.

Bone grafts can be obtained from the patient’s hip during surgery, from a cadaver bone, or created ahead of time. Bone grafting along with metal implants are needed for fusion to occur usually. Recently over 100 patients receiving bone grafts for their fusions contracted Tuberculosis from the bone grafts. This unfortunate incident highlighted the serious complications that may occur from invasive types of spine surgery such as spinal fusion and artificial discs.

When a surgeon does spinal fusion, they completely remove the disc and implant a bone graft between the troublesome, painful vertebrae and then fuse the vertebrae to form a solid unit. This solid unit limits the motion of the painful vertebrae but there is a permanent loss of movement. Complications are common and can be severe, even life-threatening.

There are several variants of Spinal Arthrodesis, including;

  1. Anterior Cervical Discectomy and Fusion (ACDF
  2. Posterior Cervical Decompression and Fusion (PCDF
  3. Transforaminal Lumbar Interbody Fusion (TLIF) 
  4. Extreme Lateral Interbody Fusion (XLIF) 
  5. Anterior Lumbar Interbody Fusion (ALIF

3. Discectomy Surgery

A discectomy procedure removes the external herniated portion of a damaged disc, relieving nerve root pressure. It does not treat back pain or neck pain, only leg pain or arm pain.  The surgeon performs this by entering the patient’s back and making holes in the bones and ligaments of the spine to get to the herniation. 

The surgeon cuts through the tissues around the vertebra with various tools and removes bone, ligament, and eventually only part of the herniated component of the disc. Surgeons are limited on how much of the herniation they can remove by how much they can see and since it is impossible to see all the herniation in a discectomy, they end up removing very little of the herniation. This is the main reason this procedure does not work well and it is not performed at Deuk Spine Institute. 

A discectomy means “cutting out the disc,” and patients can have one or more discs removed in one treatment. Different vertebrae are referred to as “levels.” The “open” approach is used to execute a discectomy. To see the spine directly, the surgeon makes a wider incision, which is more intrusive than the minimally invasive procedure.

In discectomy surgery, there is a very high chance of infection and nerve damage to the surrounding nerve roots due to the tools used for the incision and operation as well as the poor visibility. This is an older technique and does not use newer more advanced technology like the endoscope or microsurgery.

4. Microdiscectomy Surgery

A microdiscectomy procedure is very similar to a discectomy surgery. However, it uses a microscope and a 2-3 inch skin incision. A microdiscectomy is a surgical procedure that removes disc material that has spilled out and places pressure on nearby nerve roots. The surgeon creates a 2-3 inch incision on the patient’s back above the ruptured disc area during the treatment. 

The surgeon next removes bone and ligaments from the spine to gain access to the hernia after cutting the muscle away from the spine. This method is typically used for those who have sciatica, a disorder caused by compression of the spinal nerves. This procedure doesn’t treat back pain and frequently makes back pain worse. Many patients that have microdiscectomy get their symptoms back usually within a year or two and they require additional surgeries to correct the damage caused by the original microdiscectomy. 

When patients have leg weakness or numbness resulting from a herniated disc that puts pressure on the spinal nerve, this invasive method is often recommended by surgeons who do not have the ability to perform Deuk Laser Disc Repair. 

Because the surgeon must remove normal spine bone, ligaments, and joints to reach the herniated disc, instability is common and many patients require a second or third surgery to correct damage from the first. The use of the microscope means this surgery is often performed at a hospital which has a higher risk of causing infection. 

Because microdiscectomy requires the surgeon to damage the patient’s muscle, bones, spinal ligaments, and spinal joints in an attempt to remove a small portion of the herniated disc and because complications are common and recovery from the surgery requires the use of highly addictive opioid painkillers and the need for additional surgeries is likely, Deuk Spine Institute no longer performs this procedure.

5. Artificial Disc

Patients who have tried physical therapy and pain drugs yet still have unrelenting arm or leg pain are often candidates for artificial disc replacement. The surgeon removes the entire damaged disc and substitutes it with an engineered metal or plastic implant during an artificial disc surgery.

The damaged or degraded disc is removed and replaced with an artificial disc that operates similarly to a natural disc. Surgeons access the spine by shifting delicate organs aside in the patient’s abdomen or neck. 

Because of the serious problems that have been reported during the anterior (through the belly) surgery for lumbar disc problems, this is considered one of the most difficult and dangerous approaches to spinal surgery causing many surgeons and patients to avoid it. 

Patients should plan to stay in the hospital for 2-3 days after an artificial disc replacement before coming home in most cases. Usually, within 24 hours of surgery, patients will be up and walking. Compared to fusion, the goal is to eliminate pain but preserve motion at the disc operated on.

Comparison of Surgery Options for Herniated Discs

There are many ways in which the Deuk Laser Disc Repair procedure proved to be the superior choice for herniated disc treatment. Below, we highlight some of the main differences between Deuk Laser Disc Repair and other surgery options for herniated discs: 

Deuk Laser Disc RepairSpinal FusionDiscectomyMicrodiscectomyArtificial disc
Procedure typeLeast invasive laser surgery that repairs the injured disc without damaging surrounding tissues. Bandaid incision. Endoscopic. Over 2,000 patients were treated with a 99.6% success rate in the elimination of pain.Highly invasive. Surgeon uses bone graft and metal to fuse the spine.Invasive surgery where a disc is cut out. Very damaging.Invasive surgery Normal bone and ligament are removed as collateral damage.Replacement of disc with mechanical implant. Complications are common. 
Surgery timeOne hour.Long. Implant required, Prone to ComplicationHospitalization for days to manage complicationsOne hour usually. Long recovery due to damaged muscles2-3 hours but can be longer with complications
Recovery1 hour. Outpatient.Return to work and normal activities as soon as the next day. Takes 3-6 months for bones to fully fuse. Painkillers for months.Between 3-12 weeks for full recoveryFull recovery within 6 weeks to 3 monthsUp to 6 weeks required for recovery
CostRequest a free MRI consult for a quote. Usually ½-⅔ cost of invasive surgery.$60,000-$500,000$50,000-$150,000$50,000-$150,000$50,000-$150,000


How Long Does it Take for a Herniated Disc to Heal Without Surgery? 

Approximately 90% of herniated disc cases are mild and don’t require surgery.  In many cases, herniated discs can heal naturally. These cases heal within days or at most 4 weeks. 

In such cases, modest treatments such as proper rest for a few days and temporary lifestyle changes for a few weeks only will be enough to alleviate herniated disc symptoms. 

A herniated disc squeezing a nerve root may occasionally be alleviated with a variety of physical exercises. These exercises range in difficulty and can be done by anyone, regardless of previous fitness experience or history. Low-impact workouts are especially recommended because they provide the least amount of pain and discomfort while working on specific muscle groups.

Patients will often see symptoms disappearing entirely within weeks or even days. If pain or symptoms from a herniated or bulging disc last longer than four weeks, the patient should consider having the Deuk Laser Disc Repair performed. 

Waiting longer will cause other muscles and joints in the body to deteriorate and begin to cause additional pain and dysfunction. Waiting on surgery beyond 1-2 months from symptom onset is ill-advised since it causes more damage to the patient and further robs people of the quality of their lives.

More About Herniated Discs

Here’s more information about herniated discs:

MRI Herniated Disc L4-l5

L4 and L5 are identified as the fourth and fifth vertebrae within the lumbar spine, respectively. Situated in the lower back, this section of the spine comprises a total of five vertebrae, with the L4 and L5 being the two lowest vertebrae of the lumbar spine.

These vertebrae, in conjunction with intervertebral discs, joints, nerves, and other soft tissues, form the L4-L5 spinal motion segment, which has several critical functions. These include supporting the upper body’s weight and facilitating a wide range of trunk movements. Due to its significant role in bearing weight and its requirement for considerable flexibility, the L4-L5 segment is often more vulnerable to experiencing degenerative changes and pain than other segments of the lumbar spine. 

An MRI focusing on the L4-L5 segment is highly effective for diagnosing a herniated disc in this area, providing detailed images of the spine’s structures. This clarity is essential for identifying the herniation’s exact location and its impact on surrounding nerves, crucial for devising a precise treatment strategy.

MRI Herniated Disc Cost

The cost of an MRI in the United States varies widely, with prices ranging from $375 to $2,850, depending on several factors such as location, whether the procedure is performed in an inpatient or outpatient setting and insurance coverage. 

Without insurance, costs can range from $400 to $12,000. Insurance may reduce out-of-pocket expenses, but deductibles, copays, and whether the provider is in-network can affect the final cost. Both Medicaid and Medicare may cover MRI costs, subject to specific conditions​

Sciatica Herniated Disc Mri

An MRI for sciatica caused by a herniated disc helps visualize the extent of the disc herniation and its impact on the sciatic nerve. This imaging technique is crucial for diagnosing the specific location and severity of the herniation in the lumbar region, allowing for a targeted treatment approach.

Bulging Disc vs Herniated Disc Mri

A bulging disc occurs when the disc, a soft tissue between the spine’s vertebrae bones, ruptures or shifts out of its intended area. Often referred to as a ruptured or slipped disc, this condition is most commonly found in the lumbar region but can also occur in the neck area. Initially, a bulging disc might not cause symptoms because it doesn’t touch any nerves. However, it can lead to sciatica, characterized by pain, numbness, and tingling in the buttocks and legs. 

Bulging discs are often confused with herniated discs, but there is a difference. A bulging disc occurs when the interior soft tissue escapes the disc causing the disc to deflate, like a tire, and bulge outwards. A herniated disc is the result of a crack in the outer layer of cartilage that allows softer inner cartilage to come through the disk. Both can result in discomfort and should be treated by a medical professional. 

Get a free MRI review from Deuk Spine Institute today!

MRI Herniated Disc L5-s1

The L5-S1 spinal motion segment, marking the junction between the lumbar and sacral parts of the spine, is crucial for load transfer to the pelvis and legs, often subjected to intense mechanical stress. This area’s unique structure, bridging the lumbar curve with the sacral region, predisposes it to various conditions, including disc herniation, particularly at the L5-S1 level. 

An MRI can reveal a herniated disc at this site, showing the nucleus pulposus breaking through the annulus fibrosus. Symptoms vary and may not always correspond to the herniation size, with smaller herniations sometimes causing significant discomfort if they compress or irritate nearby nerves.

Cervical Herniated Disc MRI 

Cervical herniation, typically resulting from trauma or the natural aging process, manifests when a disc in the neck region protrudes due to a tear in its outer layer. This condition is relatively rare, with annual reports indicating a prevalence of less than 2%, predominantly among young adults to middle-aged individuals. 

Cervical discs support neck motion and protect the vertebrae from shock. Therefore as time passes, natural wear and tear start to occur. The cartilaginous ligaments connecting the disc to the vertebrae might become less flexible, causing it to tear from minimal force. 

A cervical herniated disc MRI plays an important role in diagnosing cervical herniated discs by providing detailed images that highlight the herniation’s impact on the cervical spine and adjacent nerves, essential for tailoring appropriate treatment strategies.

Lumbar Herniated Disc MRI 

A lumbar herniated disc develops when the nucleus pulposus, the inner gel-like core of a spinal disc, pushes through a tear or weakness in the annulus fibrosus, its sturdy outer layer. This condition typically manifests in the lower back or lumbar spine, particularly at the L4-L5 and L5-S1 spinal motion segments, which are situated at the base of the lower back.

A lumbar herniated disc MRI provides detailed images to identify the presence and extent of a disc herniation. This imaging helps visualize how the herniated disc affects surrounding tissues, including the spinal cord and nerve roots, which is essential for determining the most effective treatment approach. Lumbar disc herniations often cause lower back pain, sciatica, or numbness in the legs, making accurate diagnosis key to relief and recovery.

Get a Free Herniated Disc MRI Review 

Chronic back or neck pain can be debilitating, and finding the right healthcare provider to address it permanently is crucial. At Deuk Spine Institute, our philosophy goes beyond temporary relief. We understand the profound impact a doctor’s expertise and approach can have on your recovery journey. That’s why we focus on treatments designed to achieve lasting pain elimination.

Ready to begin? Submit your MRI online for a free, remote review to determine your candidacy for surgery. This MRI analysis involves uploading both the actual images (ideally in DICOM format) and the accompanying report. Our team of Deuk Spine Institute doctors will then meticulously review everything and create a personalized plan to eliminate your pain.

Take the first step towards a pain-free future. 


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With world-class physicians on staff, the newest and most advanced technology, and a patient experience pathway that is unrivaled in it’s efficiency and and pedagogy of care, Deuk Spine Institute has performed thousands of procedures and achieves a 95% success rate in elimination of pain.

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