Spinal Insights- Diagnosing Discs Concerns . By Chris Bowles

​Slipped disc, herniated disc, disc bulge, disc protrusion, disc extrusion, disc sequestration, torn disc, disc prolapse, squashed disc…… wow so many different names that are used for lots of different injuries interchangeably and often incorrectly. Lets clear up the naming first and then I will discuss how each may give rise to different symptoms.

A normal healthy intervertebral disc provides a cushion between the vertebrae in the spinal column.
In order of progression - the correct naming of different disc injuries are as follows.

Annular Tear
An annular tear is a rupture or tear of the fabric of the disc itself. If the disc tears and no nuclear material escapes and the disc remains the same shape it is called an annular tear and can be extremely painful as the nerves that transmit pain are located in the outer portion of the disc. Indeed there are no or limited nerve fibres in the central portion of the disc and thus non - painful. It is generally accepted that nerve fibres extend into ⅓ of the disc. Thus if an annular tear is painful we know it has reached the outer ⅓ of the disc. Below we can see the three different types of annular disc injuries.

• Rim Lesions - occur at the edge of the vertebrae from the outside in. Predictive of joint arthritis and possible future radial tear
• Concentric Tear - is a tear between layers of the disc lamellae
• Radial Tear - most common type and start from the painless inside of the annulus and progress outward toward the pain sensitive outer one third

Disc Herniation
Disc herniations are classified in different ways. Firstly they are named by the degree of nuclear migration - i.e how the softer middle bit has pushed out or pushed out and ruptured or pushed out and ruptured and then broken away.

• Protrusion also known as a contained herniation or subligamentous herniation
• Extrusion also known as a non - contained disc herniation or transligamentous
• Sequestration - free fragment broken away

The image below is a guide only but my experience is consistent with this type of correlation between disc herniation types and back and leg pain distribution. I believe it should be worded - referred symptoms - rather than leg pain - as the pain can be in the hip, groin, genitals, buttock, leg or foot (in reference to lower back disc injuries).  










​Secondly, disc herniations can be named by describing the location of the herniation.

• Central disc herniation
• Paracentral disc herniation
• Foraminal disc herniation
• Far Lateral disc herniation​

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​As you can see disc injury and subsequent diagnosis can become quite involved. I must admit this is a highly minimised version of what I would like to discuss. In a future post I will discuss the symptoms at greater depth and the various management options available. In my humble opinion the single most important step is achieving an accurate diagnosis. This will inform the most well directed treatment strategy and prevent inappropriate treatment. This process can be very drawn out for some patients and indeed many people never receive an accurate diagnosis.

If you have any questions please do not hesitate to email me on chris@healthassociates.com.au or comments are welcomed here.  

Please remember this information is educational only and does not serve to provide clinical advice to any individual. Please always seek the advice of a registered health professional.

Dr Chris Bowles
After suffering a spinal injury that resulted in the fusion of 3 vertabra and ended his rugby career Dr Chris dedicated his professional career to helping ease pain and suffering and creating an environment that keeps people doing the things they love. 
Dr Chris is available for consultations on Monday, Wednesday, Thursday and Saturday.

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