Varieties of Herniated Discs

spinal stenosis

There are many varieties of herniated discs possible in the human spine and patients love to declare their diagnosis without even understanding what it means. I am bombarded daily by readers who go to great lengths to detail the specific variety of disc concern which has been blamed for causing them so much pain, but I find that virtually none of these patients really understand the difference between the many types of disc protrusions which are possible. It is for this reason that I advise all patients to spend some time educating themselves as to the exact nature of their diagnosed spinal abnormality in order to better their participation in treatment and increase their chances for better therapy results.

There are many terms used to diagnose disc pathologies, with some being used interchangeably by care providers and others being used to differentiate specific types of bulges and herniations. Some of the more common terminologies include bulging disc, slipped disc and prolapsed disc, among others. These simply identify a herniated disc condition in one form or another, but this is just the tip of the iceberg when it comes to diagnostic terminology!

In addition to any of the above terms, certain other names may be applied to a herniated disc, signifying how or where it is abnormally affected. The first set of names which may be applied include anterior and posterior herniations. Anterior bulges are rare and are almost never considered symptomatic. Posterior herniations face into the spinal nerve structures and are therefore blamed for sourcing the majority of back pain concerns, even when no evidence of actual structural impingement or compression is noted.

Posterior herniations are further broken down into many subcategories, which detail more specifically how and where the bulge occurs. Diffuse herniated discs occur over a large portion of the disc structure. Broad based herniations account for bulges consisting of 25% to 50% of the total disc size, while focal disc protrusions involve less than 25% of the overall disc structure. All of these can occur in any of the following varieties:

Central herniated discs, are also known as median herniations, and have a tendency to bulge directly in the midline of the disc, facing directly into the middle of the thecal sac and possibly impinging upon or compressing the spinal cord or cauda equina, depending on the affected level.

Posterolateral herniated discs, also known as paramedian herniations, are the most common variety of posterior disc issue and bulge off center and into the lateral recess on one side of the central spinal canal or the other. In some cases, these bulges can enact asymmetrical central canal stenosis or may enter into the neuroforaminal space, possibly causing a pinched nerve root syndrome.

Foraminal herniated disc is the term used for a one sided herniation which also does indeed block the neuroforaminal space or even protrudes through it. These discs have the best chance of enacting nerve compression due to pressure on the nerve root as it attempts to exit the vertebral foramen.

Far lateral herniated discs, also called extraforaminal herniations, exist outside the spinal canal and may be difficult to accurately image and diagnose. Unlike most posterolateral and foraminal herniations which affect the nerve root at the same level as the disc condition, far lateral bulges may affect the nerve root above the herniation, making positive symptomatic correlation that much more difficult.

Luckily, research clearly demonstrates that the vast majority of disc herniations and bulges are not problematic and do not cause chronic back pain. For disc issues which are definitively sources of symptoms, most will respond well to appropriate treatment. If your disc issues have not resolved despite numerous therapy attempts, it may be wise to consider the very viable possibility that these structural findings are coincidental to the pain and therefore will never respond well to targeted treatment... For more information on any of these disc diagnoses, please visit the Cure Back Pain Network website detailed in the author resource section.