Disc injury, and what the words on your report mean

A disc injury means something has changed in one of the cushions between the bones of your spine. Your report may call it a bulge, degeneration, protrusion or extrusion, and each word describes a different finding. We'll go through them with your symptoms and exam, and tell you plainly if it's something we'd care for here or refer you elsewhere for.

Which disc symptoms need emergency care?

If you have any of these, go to an emergency room now. Please don't wait to see us first:

• Loss of bladder or bowel control, or new difficulty passing urine
• A change in the sensation of passing urine, such as not feeling the flow, or losing the sense of when the bowel is full
• Numbness in the saddle area: the inner thighs, buttocks, or around the genitals
• New sexual dysfunction, including new numbness in the genitals
• New or worsening weakness in both legs
• Severe back pain with fever, or an unexplained fever with new back pain. Either alone is enough

Changes in the bladder or bowel, including trouble passing urine or not feeling it, a change in feeling in the saddle area, or weakness in the legs can be signs of cauda equina syndrome, an emergency involving the nerves at the bottom of the spinal canal.

Back pain or pain running down a leg that comes with a fever, or with a history of significant infection, also needs urgent medical assessment. Weakness that keeps getting worse needs a prompt medical review.

What does an intervertebral disc do?

Discs sit between the bones of your spine and help cushion movement. Each one has a tough outer ring, the annulus, and a softer center, the nucleus. A herniation is when that inner material pushes outward, and pressure and inflammation around a nearby nerve can cause symptoms.

What do bulge, protrusion and extrusion mean on a lumbar disc report?

These definitions follow the lumbar disc nomenclature consensus, written jointly by spine societies.

Term	Meaning
Bulge	Broad extension beyond the disc boundary, generally over more than a quarter of its circumference; not a herniation.
Herniation	Localized disc material displacement involving less than a quarter of the circumference.
Protrusion	A herniation narrower than its attachment at the disc boundary, measured in the same plane.
Extrusion	Displaced material wider than its attachment in at least one plane, or disconnected from the parent disc.
Sequestration	An extrusion with a fragment completely separated from the parent disc.
Annular fissure	A separation within the outer ring's fibers. The name describes the split, not its cause, so it doesn't tell you an injury happened.

The terms describe only what the disc looks like on the scan; they don't say which finding is behind your pain or what it needs. That comes from lining it up with your symptoms and your exam.

What does disc degeneration mean?

As discs age they can lose water and height. Those changes, along with bone spurs and thickened ligaments, may narrow the spaces around the nerves, which is called spinal stenosis. Some people with narrowing have no symptoms. Others have pain, numbness or weakness, and in the lower back the symptoms can get worse with standing or walking.

What matters is which finding, if any, fits where your symptoms are and how they behave, and we'll go through that with you. If you have the report and any images, bring them. Its exact wording tells us more than "slipped disc" can.

How is a disc injury assessed?

A herniated disc may cause no symptoms at all. When a nerve is involved, a lower back disc can send pain into a leg, and a neck (cervical) disc can send symptoms into an arm. Numbness, tingling or weakness can come with the pain.

Assessing a disc problem starts with a history and an exam, which may include checks of strength, sensation and reflexes. Imaging is used when it can answer a specific clinical question, and an MRI shows soft tissues in ways an ordinary X-ray can't.

What are the treatment options for a disc injury or herniated disc?

Many people with a herniated lumbar disc improve without surgery over weeks to months. Your own course may be different.

Depending on the diagnosis and its severity, the treatment options include:

• Activity and rehabilitation: getting back to movement and exercise at a pace that suits the problem, with physical therapy when it's indicated.
• Medication: talking through the potential benefit, interactions and risks with a qualified medical professional.
• Specialist procedures: selected injections or surgery for particular cases, including urgent surgical evaluation when nerve compression is an emergency.

They aren't a ladder everyone climbs in order. Which ones make sense depends on your case.

If we think chiropractic care fits, we'll explain what it's meant to do and what the alternatives are before we ask for your consent. Spinal manipulation can leave you sore or with a headache afterward, and serious neurological complications have been reported, though how often they happen isn't clear.

What happens when you see us about a disc injury?

At Source Chiropractic, if you bring your report, we'll go through which exam findings line up with it and which don't. Only then do we recommend a plan, so it rests on what fits your symptoms, not the most alarming word on the report. Rehabilitation and a medical referral are among the options we talk through, and we'll say plainly what's still uncertain.

Our page on chiropractic and herniated discs covers the day-to-day decisions after a diagnosis.

If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider. If your report and your symptoms don't seem to match, that's worth raising at a first visit in our Clarksville office.