Clients of ABRAMS LANDAU, Ltd. are often confused by the various terms used by health care providers for what is essentially the same condition. A “Herniated Disc,” “Disc Protrusion”, “Extrusion,” “Disc Prolapse” or “Slipped Disc” all essentially mean the same thing. Doctors use these terms to explain the fact that some of the material inside the discs of the cervical (neck), thoracic (torso) or lumbar (lower back) spine have “escaped,” “leaked out” or been pressed out of their ring or band of fibrocartiledge and into the spinal canal. Part of the disc has pushed out, and this disc material may be putting pressure on a nerve or creating inflammation around the spinal cord.
Doug Landau often demonstrates to clients the difference between a “bulging disc” (where the disc material is still contained within the intervertebral disc) and a truly herniated disc (where there is a break, tear or whole in the disc and contents are now outside the fibrocartiledge). Technically speaking the diference between a Disc bulge and a disc herniation is that a disc hernation involves the inner part of the disc breaking out through the outer layers.
The disc is made up of an inner gel like part called the nucleus and an outer more cartilaginous section called the annulus. The annulus has fibers like radial car tires. We have all seen car tires that still operate with bulges. But once there is a puncture, the car may no longer function properly. So a bulge is when that annulus is pushing outward or “bulging” outward but the fibrous cover or “shell” is not broken. In a herniated disc, the inner material actually breaks through the annulus to the outside. A common analogy is a jelly donut the nucleus is the jelly and the annulus is the rest (or the outer crust) of the donut. If you squeeze the donut the jeely pushes toward one side bulging the donut on that side. “a bulged disc” When you squeeze that donut and the jelly comes out that is like a disc “herniation.” Either a disc bulge or herniated disc can put pressure on a nerve. Typically a herniation creates more pressure but this is not always the case.
[TriathlonTrialLawyer Doug Landau and Fairfax-Reston area Neurosurgeon Donald Hope, M.D. review the MRI films of an injured worker with a herniated lumbar disc.]