I Have What?

Posted on April 9, 2017 | by Admin

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.