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

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 healthcare field as to the precise definition of any of these terms, and patients are often frustrated when they hear their diagnosis referred to in various terms by different practitioners. 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 disc problems, it's generally more useful for patients to gain a clear understanding of the precise medical diagnosis, which identifies the actual cause of the patient’s low back pain, leg pain, or other symptoms.

The Medical Diagnosis

A physician’s medical diagnosis (also called “clinical diagnosis”) focuses on determining the cause 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 a review of the patient’s medical history, a complete physical exam, and, if appropriate, the results of 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 doctor a good idea of what the back problem or neck problem is.
• Diagnostic tests. After the physician has formed an opinion on the cause of the patient’s pain, a diagnostic test, such as a CT scan or an MRI scan, is often ordered to confirm the problem. The tests can give important information, such as the location of the herniated disc and impinged nerve roots.

Some practitioners advocate more extensive diagnostic tests and will recommend a discogram in order to develop as much information as possible about the patient’s condition. However, this test is expensive, invasive, painful, and is quite controversial as to whether or not it is valid, accurate test. For these reasons, many doctors do not use discography unless necessary.

Although the test findings on an MRI or other test are significant, they are not in and of themselves a diagnosis. This is because there are often lesions (anatomical problems) that show up that are not symptomatic. In fact, most people will have some level of disc problem by the time they reach 60 years of age, but few will have pain.

Quite simply, a patient’s physical exam findings and symptoms need to match the MRI or other test findings to arrive at an accurate medical diagnosis and, more importantly, an effective treatment plan for the patient, as is explained in the next page.

• Peter F. Ullrich, Jr., MD

January 10, 2007

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