I Have What?

I Have What?

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The report is in front of you. And it looks dire. Degeneration, bulges, herniations and
annular tears. It sounds terrible!

Let’s talk…
I am not a radiologist but I have seen a lot of MRI’s and MRI reports over the years.
I have taken many courses and have been privileged enough to work with several
surgeons who read the films with me, so I am going to explain this so a “regular Joe”
can understand it. This is only to help people understand that many of these phrases
and words we use are not quite as scary as they sound.
A normal disc.  Normal defines disks that are of proper size, shape and color on
the MRI. They would have a complete hard outer covering and would remain in the
“disc space” with no part of the disc going further than the vertebra above and below
it. To have all “normal discs”, you would probably be very young, not play sports and
have a sedentary job. To be quite honest, after 30, it’s a pretty rare occurrence.
An annular tear or fissure is when there is an opening in the hard outer covering
around the disc. Sometimes it leads to a disc herniation, sometimes it doesn’t. They
generally heal themselves but can often lead to disc degeneration because the
normal fluid in the disc leaks out. The word “fissure” is preferred as it does not
imply trauma.
A disc herniation refers to a displacement of disc material beyond the normal
confines of the disc. The herniation can include disc material, cartridge, bone or
annular tissue (or a combination of all of these). The herniation is further
described as either a protrusion or an extrusion.
A protrusion means that the base of the herniation is wider than the rest of it and
the outer fibers of the disc outer covering (annulus) are intact.
An extrusion is when the base (or neck) of the herniation is narrower than the piece
that comes out of the disc. The hard out covering is torn and the piece may hang
down or float up in the spinal canal.
A bulging disc is something no one  seems to really agree upon. In 2014 The American
Society of Spine radiology describe it as “annular tissue projecting beyond the
margins of the adjacent vertebral bodies, over more than 90° circumference”.
It also says a circumferential bulge involves the entire disc circumference and
an asymmetric bulge does not involve the entire circumference but more than 90°
of the disc.
In other studies and articles a bulging disc is not considered a form of herniation
but a descriptive term of the shape of the disc contour.  Symmetrical bulging disc is
when the whole disc has tissue beyond the edges and an asymmetrical bulging disc
is within the bulging is only noted from one part of the disc still greater than 90°.
Needless to say, every radiologist, according to age, training and vernacular would
describe a bulging disc differently.
The big thing to remember is that no good surgeon “operates on an MRI” which
means we look at the patient and see what their symptomology is and compare it
to the MRI. A person could have 3 herniated discs and no pain or weakness. They
would most likely not require surgery. Someone else could have a small disc that
presses directly on a nerve and not get better over time, or with conservative care,
and would require surgery.
So, calm down. It sounds bad but very often that horrible sounding MRI is normal
for someone of your age and circumstance. Remember a disc herniation or a disc
bulge is only a problem if it is causing one.

Citations

  • Herzog R, Elgort DR, Flanders AE, Moley PJ. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J. 2017 Apr;17(4):554-561. PubMed PMID: 27867079

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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