I Think I Have a Slipped Disc Doc!

I have heard this phrase more than once during my 21 years of private practice.  These patients are almost always shocked when I tell them that there is no such thing as a slipped disc!  I tell them that discs can tear, rip, herniate, and bulge, but since they are attached to the bone above and the bone below, their is no way that they can "slip". Once I explain this, the patient usually always asks, "so what is a bulging disc?"

And that, my friends, is a very complicated answer.

First of all, a little anatomy.  As you can see in the picture, the disc is the specialized cartilage material between the bones or vertebra of the spine. It is made up of two primary parts, namely the Nucleus Pulposus and the Annulus Fibrosus.  The nucleus is a very fluid type of material, having a consistency similar to grape jelly. The annulus is layer upon layer of strong fibrous bands.  Think of the disc as a small hydraulic cylinder.  Look at the picture again. See how close the disc is to the Nerve Root and the Spinal Cord?

So, what is a bulging disc? How about a disc protrusion?

I recently obtained a report for an MRI of a patient's spine. (MRI stands for Magnetic Resonance Imaging, but that is best left for a future post).  In the report, the radiologist described disc bulges and protrusions. I knew that the patient deserved and needed the most accurate report from me regarding the examination and report, so I called the radiologist for further clarification.

He was very kind and helpful, but also expressed the same frustration with the use of the terms that I have experienced.  The problem is that the terms are often inappropriately used, and the definitions have become blurred.

This is what he taught me on the phone, in a nutshell...

A disc bulge is a very broad based extension of the annular fibers past the border of the vertebral body. A disc protrusion is a more localized and focal disc bulge extending beyond the vertebral body. The term Herniation is often used when it is somewhere between a bulge and a protrusion.  Are you confused yet?

An extrusion is a condition in which the nucleus, or central part of the disc has ruptured through the outer fibers of the disc and is now beyond the annular rings.


As for what this all means for the patient. All of the above listed disc injuries can cause some serious pain and disability. The bulging, herniating, or protruding disc can cause pressure on the spinal cord and other nerves. Even the slightest of pressure or irritation can cause significant pain.  The good news, however, is that only the most severe of these requires surgical treatment. 95% of all disc problems can be treated through conservative, non-surgical care. This includes chiropractic, acupuncture, massage, etc.  Spinal surgery is risky, and usually should be done when other options have been exhausted.

Keith Biggs, DC

www.eastmesachiropractor.com
biggschiroopractic@gmail.com