What is a Herniated Disc?

If you've ever been in a car accident, then you've probably had an X-ray or an MRI of your spine.  These days, having an X-ray of your spine is a standard procedure after experiencing some form of trauma because all of the nerves in your body run through the spinal canal in one way or another.  For example, a spinal injury can result in foot pain, even when there is no apparent damage to your foot, but more commonly spinal injuries can result in shoulder and back pain. 

One of the most common forms of a spinal injury is a herniated disc.  Herniated discs come in various shapes and sizes, and there are numerous medical terms doctors use to describe this type of injury.  Some doctors use these terms interchangeably, which can cause confusion to the patient and especially to attorneys and a jury when these injuries are described.  Some of the commonly used words used to describe a herniated disc are disc bulge, disc protrusion, disc extrusion or ruptured disc.

Spinal discs exist between the vertebrae bones in our spine.  They are like little pillows that act as cushions between our vertebrae bones and allow our spine to bend and flex.  When a spine is subjected to some kind of trauma, these discs bear the brunt of the force and, depending on the kind of trauma, will squish out from between our vertebrae.  When this happens it is generally called it a herniated disc. 

Your doctor may call your disc herniation a "disc bulge", a "disc protrusion" or a "disc herniation".  Despite some doctors using these terms interchangeably, there are important differences between these terms. 

- A disc bulge is most commonly associated with a disc that has been compressed between two vertebrae, and has begun to slightly bulge out of alignment with the spine.  This bulge may not cause any nerve pain. 

- A disc protrusion is most commonly diagnosed where acute trauma forces the disc to protrude out of one particular area of the spine.  Contrast this with a disc bulge where the disc simply bulges out as if evenly compressed between the vertebrae.  A protruding disc is most often associated with a car accident or some other trauma where the force of an impact only occurs on one side of the body.  A protrusion can cause nerve pain where it impinges on the area of the spine where the nerves are located, or where it "abuts the thecal sac."  Because the nerves in the spine are so sensitive, even a minor intrusion on the area can cause nerve pain, but this is not always the case.  Some patients who have significant impingement on their nerves experience little or no pain at all, while others with only a minor impingement can suffer from debilitating pain. 

- A disc herniation is most commonly identified when the disc actually ruptures from a bulge or a protrusion.  Some doctors will not call a bulging or protruding disc a herniation unless there is evidence of a rupture, while others will consider the disc herniated if it is protruding out from between the vertebrae.  Also, some doctors consider a disc bulge to be a less serious disc protrusion rather than a flattening of a disc. 

Doctors have identified two different types of disc herniation where the actual disc has ruptured. 

The first type is called a "disc extrusion" where the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the disc to squeeze out.  A disc extrusion can occur with the ligaments either intact or damaged.  The second type of disc rupture is called a "disc sequestration" which occurs when the center, gelatinous portion of the disc is not only squeezed out, but also separated from the main part of the disc.  A disc sequestration is the most severe type of disc hernia. 

Spinal Injuries Causing Accelerated Degeneration of the Spine. 

Disc bulges and protrusions are commonly associated with trauma particularly in young people. As we age the discs in our spines begin to wear out and shrink.  The less cushion we have between our vertebrae the more they rub together, causing various forms of degeneration.  This degeneration is very common in people over the age of 55 and is not generally associated with any trauma.  However, if you have suffered trauma to your spine at an early age, disc degeneration in your spine may occur sooner.  Once you damage a disc it usually stays damaged. 

When it comes to spinal disc injuries or degeneration, doctors tend to focus on treating the pain of the patient rather than the cause.  Doctors do not have many options to treat spinal disc injuries outside of steroid injections into the spine to treat the pain, or surgical spinal fusion to prevent wear and friction on the vertebrae.  Spinal fusion tends to have its own side-effects however in that a fused vertebrae tends to put more pressure on adjacent vertebrae, causing further accelerated degeneration. There are some new procedures being developed to repair or replace damaged spinal discs, but these options are only available to very select patients, and only after all other treatments have failed.