The Severity of a Bulging Disc

A 'disc bulge' is a word used to describe findings seen on an MRI study of the spinal discs. The spinal discs are soft cushions that rest between the bones of the spine, the vertebrae. A normal spinal disc is critical to mobility of the spine. The disc functions to absorb energy in the spine, yet also allow the spine to bend and rotate. When a disc is damaged, it may herniate, or push out, against the spinal cord and spinal nerves.

A 'disc bulge' is a word commonly used to describe a slight outpouching of the disc. The words 'disc bulge' imply that the disc appears symmetric with a small amount of outpouching, and no significant herniation. Specifically, disc bulges do not penetrate the ligament barrier that separates the disc from the spinal canal. 

Disc bulging is often an incidental finding on MRI. As people age, disc bulges are commonly seen on MRI. Disc bulges can be seen in patients with no symptoms of back problems, especially in patients over the age of 40. A physical examination can help distinguish a disc bulge that is causing problems from a disc bulge that is an incidental finding.

A bulging disk
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Should You Worry About a Bulge?

A finding of a bulging disc is difficult to interpret in isolation. For the most part, bulging discs are very normal findings, even in young, active patients, and they are rarely thought to be a source of back pain. If anything, a significant disc bulge would be expected to cause leg pain as a result of irritation to the nerves going down the legs.

Radiologists often detect disc bulging on an MRI and often include this finding in an MRI report. This can cause anxiety for patients who worry they are developing a serious spinal problem. However, studies have shown over and over, that disc bulges are incredibly common, and can be seen on MRIs of people without back pain or spine problems.

Treatment of Disc Bulges

The truth is, most disc bulges don't need treatment, but the cause of back pain needs to be better understood and treated. MRIs are not perfect tests, and the fact is they allow us to "see" a bulging disc, but we often don't see muscle strains or ligament injuries. The vast majority of cases of back pain are dues to muscular strains, and therefore treatment is often targeted at improving the function of the muscles of the spine and core.

The other key to understand is that disc bulges often are a normal finding of an MRI. As we age, MRI appearances change. It is well known that young people in their 20s will often show 'abnormalities' on MRI scans. That doesn't mean the abnormality is the cause of their pain, it may just be a normal finding for that individual.

There are some situations when the discs are abnormal and can be a source of pain. When the disc is the source of pain, people often refer to this as discogenic back pain. It should be noted that while a disc may be the source of low back pain, it is usually not the case; discogenic back pain remains a controversial diagnosis. This is not quite the same as a bulging disc, although discogenic pain can occur in people who have a bulging disc. Rarely are invasive or surgical treatments used for the treatment of a bulging disc.

4 Sources
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  2. Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-516. doi:10.1007/s12178-017-9441-4

  3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-6. doi:10.3174/ajnr.A4173

  4. Fujii K, Yamazaki M, Kang JD, et al. Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus. 2019;3(5):e10180. doi:10.1002/jbm4.10180

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.