Why in medicine do we have so many terms to describe the same thing? Is it frustrating for you to hear that you don’t have a “disc herniation” you have a “disc bulge” from 2 different clinicians while the radiologist’s report called it a “disc protrusion or extrusion? A colleague of mine, Joe Higgins, OTR once said that in medicine “We would rather use each other’s toothbrushes than each other’s language.” Not uncommonly treatment is diverted by clinicians based on the confusion, lack of understanding or just plain misunderstanding of this medical terminology. I will give you my humble simplification of these terms: Disc Bulge-A normal physiologic or age-related rounding or flattening of the disc cartilage. Capable of causing some mild numbness, tingling or pin and needles but no pain. Disc Herniation-A pathologic condition where the center nuclear material migrates through the cartilage seen most commonly over a prolonged period of repeated flexion and/or rotation movements. Capable of causing back and/or leg pain. This occurs as enzymes are released from this center nuclear material and less commonly, in fewer than 5% of patients, weakness. An estimated 40% of people who never had back or leg pain will have a disc herniation on an MRI scan. Types of disc herniations: Protrusion-This herniation is broader than it is deep. Extrusion-This herniation is deeper than it is broad. Sequestration-This herniation has a free fragment that is no longer attached to the rest of the disc. All 3 of these above terms are forms of herniations whether the term herniation appears or not on a radiology report. Anular Tear-This term applied to tears in the cartilage portion of the disc which in some cases is and in other cases is not painful. Stenosis-A term applied to a narrowing of the spinal canal. When symptomatic, the patient typically will say they are worse with standing and walking and relieved with sitting or forward bending. Don’t be confused if a radiology report fails to contain this term and you see narrowing of the central or nerve canal. This narrowing is another way to say stenosis. Interestingly, by the time we are in our nineties we will all have stenosis on an MRI scan but not all will be symptomatic. Degenerative Disc Disease-This is a term that will no longer be used in the future as it implies a disease process is present. Most of the time this is thinning of the disc and is a normal process of wear and tear as we age. Stay tuned for some clarifications on confusing terms in the field of sports medicine later this week.
Posted on: Thu, 07 Aug 2014 16:00:40 +0000
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