Disc Bulges, Protrusions, and Extrusions… What do they all mean?

Disc Bugles

Disc bulge

Disc bulges are commonly seen on the MRIs of individuals experiencing back pain.  

Patients with bulging discs can experience a range of painful symptoms that vary greatly, including, severe pain when getting up from a prostrate position (such as first thing in the morning,) shooting pain, numbness and tingling sensations that radiate down the leg, and chronic back pain when performing everyday tasks.

An MRI is a picture of a moment in time that doesn’t necessarily illustrate the whole story. It cannot show the level of discomfort that occurs when the patient performs routine activities such as picking up children or grocery bags, or opening car doors, nor does it predict the likelihood of the bulging disc herniating by increasing intradiscal pressure.

When the bulging disc was not present before the patient was involved in a MVA, it should be not be tossed in the “common finding” file, but further investigated as a quality-of-life-altering injury.

Disc herniation/protrusion

A disc herniation or protrusion can be likened to a jelly donut experiencing its filling forcefully seeping through the walls of the dough.

Often easier to detect than bulging discs, herniations can cause central back pain that shoots down the leg when moving to a standing or sitting position, accompanied by numbness and tingling in both legs. If left untreated, it can cause weakness, atrophy and a permanently altered gait, such as limping in favor of the side opposite the disc herniation.

Disc extrusion

Sticking with the jelly donut analogy, extrusion is when the the jelly has ended up far away from the donut’s center and likely to float outside of its intended space. This is a worse scenario than the disc protrusion, resulting in more severe pain that may be present even when the patient is trying to sleep. Lack of consistent quality sleep leads to the patient experiencing overwhelming fatigue, lack of mobility and the onset of mood changes such as irritability and depression, in addition to chronic pain.

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