Disc bulges, protrusions, and extrusions…what do they all mean?

Disc bulge

Bulges may be a common finding, but a bulge after a motor vehicle accident (MVA) should not always be dismissed as a “common finding”.

One common complaint I get from my patient, Mr. Smith for example, is: “Doc, don’t tell me that my back is normal. Don’t tell me that those disc bulges are a normal finding and that they were there before the 18-wheeler hit me. I wake up with excruciating back pain, it radiates down my right thigh, and it is a shooting pain. I have numbness and tingling down my right leg as well.” Sometimes Mr. Smith is already “Google-educated” when it comes to disc bulges and is concerned that disc bulges can be a common finding among asymptomatic individuals…yet he persists with back pain, despite having only disc bulges on MRI.

An MRI is a picture of a moment in time, not necessarily telling you the whole story. It doesn’t tell you what happens when Mr. Smith is bending over picking up his kid. It doesn’t show how a disc can herniate by increased intradiscal pressure.

Disc herniation/protrusion

A herniation is like when a jelly donut has the jelly tear through the walls of the dough and seeps out.

Herniations are easier to detect. They can cause central back pain and pain that shoots down the leg. Mr. Smith’s pain is constant; present when he stands and when he sits. He has numbness and tingling in both legs. If left untreated it can cause weakness and atrophy. Mr. Smith may be limping, preferring the side opposite the disc herniation.

Disc extrusion

Extrusion is when the piece of the jelly is far away from the donut’s center and about to float outside of the donut space.

This is a worse scenario than the disc protrusion. Mr. Smith’s pain may be more severe and be present even while he’s trying to sleep. The situation can be bad enough that Mr. Smith doesn’t get much sleep and is fatigued, tired, and is starting to feel depressed from pain and decrease in function.


Contact MD Certified Life Care Planner by email admin@mdclcp.net or by phone 512-960-4717 to discuss your case with a board certified PM&R/Pain Management physician, Dr. Miranda Grajales, or a board certified Neurologist, Dr. Rundle-Gonzalez. Both doctors are fluent in Spanish and are certified life care planners.

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Three Very Important Issues Affecting Traumatic Brain Injury (TBI) Patients All Life Care Planners Should Know

Often times, TBI or Traumatic Brain Injury, is termed as a silent epidemic since, for several years, such injuries failed to receive proper diagnoses and, therefore, went untreated. To compound the situation, the medical profession frequently dismissed complaints of personality changes, memory loss, and decreased mental processing ability as completely unrelated occurrences. Thankfully, TBI recognition has changed significantly today, and TBI patients have access to different resources in the community to address their impairment and handicap (like vocational rehabilitation, neuropsychological testing, brain injury medicine fellowships, etc.).

As life care planners, we get consulted long after the date of the injury and when most of the injuries have healed. It behooves us to keep in mind that some of the cases we work on involve patients with undiagnosed TBI.

The following are 3 very important concepts all life care planners should keep in mind when authoring plans on the TBI population.

1. Difficulty of TBI patients obtaining gainful employment

TBI patients face several hurdles in finding gainful employment. For younger individuals with limited or no work experience the challenge can be acute and can potentially drive them to despair. Persistent impairments like difficulty in reasoning, communication, problem-solving, memory, as well as difficulties in focusing in even simple tasks can further accentuate the challenge. In some instances, TBI can leave people with physical, behavioral and emotional problems further impacting their employability. There may even be a social barrier in the workplace, where co-workers and employers have concerns or fears on working with/employing patients with TBI. Social support groups and going through a Brain Injury Program, like the Mary Lee Foundation (in Austin, TX) can be life changing. These programs help train TBI patients to enter a work setting that suits the individual. A main focus of the rehabilitation aspect of a brain injury patient is the achievement of independent living.

2. Increased risk of developing early dementia and early Parkinson’s Disease

Early dementia and early Parkinson’s Disease are among the most feared long-term consequences of TBI. Several studies have shown that individuals who experienced a TBI in the early or mid stages of their life have an enhanced risk of dementia in the later years of their life (DH Smith, VE Johnson, W Stewart – Nature Reviews Neurology, 2013). The risk factor can be as much as 4-fold depending on the severity of TBI. However, mild head injuries, which are also sometimes termed concussions, are not well documented and retrospective studies may be impacted by recall bias. But these mild TBIs can come into focus particularly when the affected individual is an athlete (boxer or football player, for example) or a military person.

3. Dependence on social support in order to function on a daily basis

Depending on the severity of the brain injury, there is a likelihood the victim may become fully dependent on others in order to function. Even if the patient is independent for most ADLs (eating, bathing, dressing), he/she may not have the wherewithal to communicate effectively outside the household. In these scenarios where the functional impairment is not too obvious, the caregiver’s account of a day in the life of the patient is key in assessing the degree of impairment. If the patient still has good introspection of his/her disability, he/she may develop symptoms of helplessness and depression, which compounds the problem. In these circumstances, social and emotional support are invaluable to the wellbeing of the patient.

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Tel: 512-960-4717
Email: admin@mdclcp.net
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Suite C-213
West Lake Hills, TX

We also offer PM&R (Dr. Miranda-Grajales) and Neurology (Dr. Rundle-Gonzalez) evaluation/treatment, for more information call 512-960-4717.