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What’s the Difference Between a Disc “Bulge” and a “Herniation?”

George Rappard, MD and Anand Joshi, MD

Sometimes, being able to spot the differences in something is not only elusive to lay people, but to professionals as well.  This is the case with abnormalities in the disc, the cushion between the bones of the back, called the vertebrae..   Being able to identify disc abnormalities is important because they can be painful. While doctors can easily identify a large or obvious abnormality of the disc, being able to define more subtle abnormalities can be difficult.  This difficulty led several spine related professional medical societies, the American Society of Neuroradiology, the American Society of Spine Radiology and the North American Spine Society to develop recommendations for how to name certain conditions of the disc.  The first set of recommendations was published in 2001. These recommendations were later revised in 2014.  Since first published, these recommendations have been adopted by major orthopedic, neurosurgical, radiologic and rehabilitation organizations in the United States.

Firstly, one must be able to define what a normal disc is.  In 2014, a normal disc is described as one that has a normal shape and does not have evidence of degeneration [2]. The recommendations further write that the normal disc is maintained wholly within the boundaries of the disc space, and defines what those boundaries are (see Figure 1).  Therefore a normal disc is not only normally-shaped, but also does not extend beyond its usual boundaries and does not have evidence of degeneration. It is important to note that, in this context, “normal” simply is meant to describe the size and shape of the disc. The 2014 guidelines note that the discs’ size and shape often does not match-up very well with pain or other types of disease. In other words, disc degeneration and other wear-tear changes are commonly seen and cannot be used to diagnose the source of pain or other disease.

Continue Reading about the Difference Between Disc Herniations & Bulges at KnowYourBack.org.

 

 

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