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.
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.
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.