What's a Herniated Disc, Pinched Nerve, Bulging Disc...?

Herniated Disc Videos

There are many different terms used to describe spinal disc pathology and associated pain, such as “herniated disc”, “pinched nerve”, and “bulging disc”, and all are used differently by doctors.

Unfortunately, there is no agreement in the health care field as to the precise definition of any of these terms, and patients are often frustrated when they hear their diagnosis referred to in different terms by health care practitioners. A variety of additional terms such as ruptured disc, torn disc (or disc tear), slipped disc, collapsed disc, disc protrusion, disc disease, and black disc often add to a patient's confusion.

Rather than try to reconcile the terminology used to refer to a herniated disc or other disc problems, it's generally more useful for patients to gain a clear understanding of the precise medical diagnosis, in other words, to gain an understanding of the actual cause of the upper or lower back pain, leg pain, neck pain or other symptoms.

The spine care professional arrives at a clinical diagnosis of the cause of the patient’s pain through a combination of a review of the patient’s medical history, a complete physical exam, and, if appropriate, the results of one or more diagnostic tests.

Two Causes of Pain: Pinched Nerve vs. Disc Pain

In identifying the cause of the patient’s pain, there are two general types of spinal disc problems physicians classify as the cause of the pain:

• Pinched nerve – When a patient has a symptomatic herniated disc, it is not the disc space itself that hurts, but rather the disc herniation is pinching a nerve in the spine. This produces pain that is called radicular pain or radiculopathy (e.g., nerve root pain) leading to pain that may be referred to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain stemming from a pinched nerve in the lower spine is usually described as sciatica.
  On Spine-health, this type of condition where there is nerve root pain is referred to as a herniated disc. Other causes of a pinched nerve may include spinal stenosis and bone spurs from spinal arthritis.

• Disc pain – When a patient has a symptomatic degenerated disc (one that causes low back pain and/or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain. On Spine-health, this type of condition where there is actual disc space pain is referred to as degenerative disc disease.

Either of the above two conditions can occur in the neck, upper back or lower back. They tend to be most common in the lower back because the lower back bears the most torque and force on a day to day basis.

It should be kept in mind that all the terms – herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc.– refer to radiographic findings seen on a CT scan or MRI scan. While these test results are important, they are not as meaningful as the patient's specific symptoms and the doctor's physical exam results are in determining the source of the back pain and then evaluating potential back care and pain treatments.

• Article written By:
• Peter F. Ullrich, Jr., MD

July 31, 2009

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