Bulging Disc... Herniated Disc... Slipped Disc...
Protruding Disc... Degenerative Disc... Ruptured Disc
Are These ALL the Same Thing?
By Dr. Donald Liebell
The answer to the headlined question is NO. Nevertheless, all of these above terms are frequently (and quite incorrectly) used interchangeably, by both doctors and the lay public. Each of these terms refers to a classification of damage to the intervertebral discs of the spine. These are the shock-absorbing cushions between the bones of the spine (vertebrae). Regardless of how disc problems are classified, they don’t necessarily cause pain or other symptoms. Sometimes they do; sometimes they don’t. If a disc is NOT putting pressure on a spinal nerve enough to interfere with the nerve’s function, it won’t give you trouble. In other words, bad discs don’t always hurt.
A Quick Anatomy Lesson:
A spinal disc has two main parts. The annulus is the tough outer layer of the disc. The nucleus is a soft jelly-like inner core of the disc. Just picture a jelly doughnut. Think of the annulus as the doughnut part and the nucleus as the jelly part and I’m sure you’ll understand. See the spinal nerve roots in the diagram below. Notice how close they are to the disc. If there's a problem with the disc, it can affect the spinal nerve.
Let’s take a look at the different disc problems.
Degenerative Disc: Imagine a kitchen sponge. It’s plump and full of water. Squeeze the water out of the sponge and let it dry out. That’s sort of like a degenerative disc. Degenerative disc disease is the term for an “arthritic” disc or "arthritis" of the neck. Not only is the disc itself dried out and thinner, but there are also bone spurs in the area.
(Click HERE to learn why Arthritis gets blamed too much)
Bulging Disc: A bulging disc looks different from a herniated disc. Imagine pressing down on a jelly doughnut. It flattens and widens outward or “pancakes,” but doesn’t squeeze out the jelly. The doughnut part (the annulus) does not tear, which would allow the jelly to ooze out into the spinal canal. A “bulging disc” is the same as a “protruding disc.” With a bulging or protruding disc, the surrounding ligaments remain intact. Another way of understanding a bulging disc is to imagine pressing down on a balloon, but NOT hard enough to make it pop.
Herniated Disc: Imagine the same jelly doughnut. In the case of the herniated disc, the doughnut part has torn enough to let the jelly ooze out of the doughnut. Or imagine pressing down on the balloon, but this time enough to make it pop. Basically a herniated disc is worse than a bulging disc. The term “ruptured disc” is appropriately used to describe a herniated disc. Another term for herniated disc is “extruded disc” or "prolapsed disc." If an MRI report reveals a disc extrusion, you’ve got a true-blue, full-blown herniated disc.
What could be worse than a herniated disc?
There’s one more type: the Sequestered Disc. A sequestered disc is a herniated or ruptured disc that has a portion of the disc jelly broken off and separated from the rest of the disc.
Bulging discs, herniated discs and protruding discs are essentially all forms of “slipped discs.” “Slipped Disc” is not exactly a specific medical term. But it’s good enough for most folks! I can’t stress enough that bulging and herniated discs most certainly do NOT always cause pain and dysfunction. Spinal Nerve Root compression must be severe enough to cause nerve interference. We simply cannot assume that the mere presence of a herniated disc, a bulging disc, a degenerative disc, or even a sequestered disc is the cause for a person’s pain. It could even by one of several reasons for the pain. This is one of the reasons why doctors such as myself have been able to end neck and back pain, and many related conditions without neck or back surgery.
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- Dr. Donald Liebell