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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:

Pinched nerve

Sciatica

Herniated disc (or herniated disk)

Bulging disc

Ruptured disc

Slipped disc

Disc protrusion

Disc degeneration

Degenerative disc disease

Disc disease

Black disc

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 Spine-health.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 Spine-health.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.