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

There are many terms used to describe spinal disc pathology and associated pain, such as "herniated disc," "pinched nerve," and "bulging disc," and all are used differently and, at times, interchangeably.

Unfortunately, healthcare professionals do not agree on a precise definition of any of these terms, and patients may be frustrated when they hear their diagnosis referred to in different terms. The unusually wide range of terms used to describe spinal disc problems (such as ruptured disc, torn disc, slipped disc, collapsed disc, disc protrusion, disc disease, and black disc) can add to the confusion.

Lumbar herniated disc. Click to enlarge

Rather than caring about which term is used to describe the disc, it is more useful for patients to gain a clear understanding of the precise medical diagnosis.

The medical diagnosis identifies the actual cause of the patient’s back pain, leg pain and other symptoms.

Medical professionals determine the cause of the patient’s pain through a combination of the following three steps:

  • Review of the patient's medical history
  • A complete physical exam
  • One or more diagnostic tests (if needed)
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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 used by physicians:

    Pinched nerve. When a patient has a symptomatic herniated disc, the disc itself is not painful, but rather the material that is leaking our of the inside of the disc is pinching or irritating a nearby nerve. This type of pathology produces pain called radicular pain (e.g., nerve root pain) leading to pain that may radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is usually described as sciatica.

    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.

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Either of the above two conditions can occur in the cervical (neck), thoracic (upper) or lumbar (lower) spine. 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 in determining the cause of the pain as the patient's specific symptoms and the doctor's physical exam results.

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