What's a herniated disc, pinched nerve, bulging
disc...?
Spinal disc pain terminology varies
There are
many different terms to describe spinal disc pathology
and associated pain, such as “herniated
disc”, “pinched nerve”,
and “bulging disc”, and all are
used differently by different healthcare practitioners.
Unfortunately, there is no agreement in the healthcare
field as to the precise definition of any of these
terms. Often the patient hears his or her diagnosis
referred to in different terms by different practitioners
and is left wondering if there is any consensus on
what is wrong.
Some examples of terms used to describe spinal disc
abnormalities include:
Rather than focus on the terminology referring to
spinal anatomy, it's most helpful for patients to focus
on understanding the medical diagnosis, which identifies
the actual source of the patient’s low back pain,
leg pain, or other symptoms.
Integrated findings form the medical diagnosis
A physician’s medical diagnosis (also called “clinical
diagnosis”) focuses on determining the source
of a patient’s pain. For this reason, the medical
diagnosis of a patient’s low back pain, leg pain,
or other symptoms is based on more than just the findings
from a diagnostic test, such as an MRI scan or CT scan.
Instead, the spine care professional arrives at a clinical
diagnosis of the cause of the patient’s pain
through a combination of findings from a thorough medical
history, conducting a complete physical exam, and,
if appropriate, conducting one or more diagnostic tests.
-
Medical history. The physician will take
the patient’s medical history, such as a
description of when the low back pain, sciatica
or other symptoms occur, a description of how the
pain feels, and what activities, positions or treatments
make the pain feel better, and more.
-
Physical exam. The physician will conduct
a thorough physical exam of the patient, such as
testing nerve function and muscle strength in certain
parts of the leg or arm, testing for pain in certain
positions, and more. Usually, this series of physical
tests will give the spine professional a good idea
of the type of back problem or neck problem that
the patient has.
-
Diagnostic tests. After the physician has
a good idea of the source of the patient’s
pain, a diagnostic test, such as a CT scan or an
MRI scan, is often ordered to confirm the presence
of an anatomical lesion in the spine. The tests
can give a detailed picture of the problem, such
as the location of the herniated disc and impinged
nerve roots.
Although the anatomic findings on an imaging study
bear certain significance, they are not in and of themselves
diagnostic. There can be lesions present on an
imaging study that are not symptomatic. A patient’s
physical exam findings and symptoms need to match the
anatomic findings to arrive at an accurate medical
diagnosis.
Medical diagnosis determines the pain generator
The key factor in the clinical diagnosis is to
determine if the patient has a pinched nerve or if
the disc space itself is generating the pain. These
two common conditions produce a different type of 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 (e.g., nerve root pain,
or sciatica from a lumbar herniated disc, or arm
pain from a cervical herniated disc).
On op90.com, this type of condition is referred
to as a herniated disc.
- Disc pain: When a patient has a symptomatic
degenerated disc (one that causes low back pain or
other symptoms), it is the disc space itself that
is painful and is the source of pain. This type of
pain is typically called axial pain.
On op90.com, this type of condition is referred
to as a degenerative disc disease.
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 (x-rays can indicate disc
degeneration but cannot actually image the disc itself).
While radiographic findings are important, they are
not as meaningful in determining the source of the
pain (the clinical diagnosis) as the patient's specific
symptoms and the spine specialist's findings on physical
exam.
Pinched nerve pain and disc space pain treatments
differ
It's critical to accurately diagnose the
pain generator, because the type of pain created
by the spinal disc dictates the type of treatment,
and the treatments for the different diagnoses vary
considerably. For example, treating a lumbar herniated
disc will not do the patient much good if it is a
muscle strain or other soft tissue injury rather
than the disc herniation that is the cause of the
patient’s pain.
For more information and treatment options on a pinched
nerve that causes radicular pain, see articles on herniated
disc or disc herniation (the chosen terminology
on op90.com), such as:
For more information and treatment options for disc
space pain, see articles on degenerative disc disease,
such as:
By: Peter
F. Ullrich, Jr., MD
October 13, 2000 (updated July
18, 2005)
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