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Spine
Diagnosis
Degenerative Diseases and Arthritides
Degenerative Diseases
Disc Bulge
Disc Bulge
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Anular bulge, annular bulge, bulging disc

            • Definitions

              • Generalized extension of disc beyond edges of vertebral ring apophyses
                • > 25% of disc circumference
                • Typically extends < 3 mm beyond edge of apophyses

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Nuclear Medicine Findings

                        • Other Modality Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Li Y et al: How should we grade lumbar disc herniation and nerve root compression? A systematic review. Clin Orthop Relat Res. 473(6):1896-902, 2015
                                            2. Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
                                            3. Hadjipavlou AG et al: The pathophysiology of disc degeneration: a critical review. J Bone Joint Surg Br. 90(10):1261-70, 2008
                                            4. Walker J 3rd et al: Discography in practice: a clinical and historical review. Curr Rev Musculoskelet Med. 1(2):69-83, 2008
                                            5. Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61, 2007
                                            6. Urban JP et al: Pathophysiology of the intervertebral disc and the challenges for MRI. J Magn Reson Imaging. 25(2):419-32, 2007
                                            7. Ido K et al: The validity of upright myelography for diagnosing lumbar disc herniation. Clin Neurol Neurosurg. 104(1):30-5, 2002
                                            8. Lebkowski WJ et al: Degenerated lumbar intervertebral disc. A morphological study. Pol J Pathol. 53(2):83-6, 2002
                                            9. Botwin KP et al: Role of weight-bearing flexion and extension myelography in evaluating the intervertebral disc. Am J Phys Med Rehabil. 80(4):289-95, 2001
                                            10. Fredericson M et al: Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects. Spine J. 1(1):10-7, 2001
                                            11. Adams MA et al: Mechanical initiation of intervertebral disc degeneration. Spine. 25(13):1625-36, 2000
                                            12. Luoma K et al: Low back pain in relation to lumbar disc degeneration. Spine. 25(4):487-92, 2000
                                            13. Milette PC et al: Differentiating lumbar disc protrusions, disc bulges, and discs with normal contour but abnormal signal intensity. Magnetic resonance imaging with discographic correlations. Spine. 24(1):44-53, 1999
                                            14. Sambrook PN et al: Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum. 42(2):366-72, 1999
                                            15. Harada A et al: Correlation between bone mineral density and intervertebral disc degeneration. Spine. 23(8):857-61; discussion 862, 1998
                                            16. Cowan NC et al: The natural history of sciatica: a prospective radiological study. Clin Radiol. 46(1):7-12, 1992
                                            17. Maezawa S et al: Pain provocation at lumbar discography as analyzed by computed tomography/discography. Spine. 17(11):1309-15, 1992
                                            18. Ito S et al: An observation of ruptured annulus fibrosus in lumbar discs. J Spinal Disord. 4(4):462-6, 1991
                                            19. Bernard TN Jr: Lumbar discography followed by computed tomography. Refining the diagnosis of low-back pain. Spine. 15(7):690-707, 1990
                                            20. Tervonen O et al: Lumbar disc degeneration. Correlation between CT and CT/discography. Acta Radiol. 31(6):551-4, 1990
                                            21. Kambin P et al: Annular protrusion: pathophysiology and roentgenographic appearance. Spine. 13(6):671-5, 1988
                                            22. Sachs BL et al: Dallas discogram description. A new classification of CT/discography in low-back disorders. Spine. 12(3):287-94, 1987
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Anular bulge, annular bulge, bulging disc

                                                      • Definitions

                                                        • Generalized extension of disc beyond edges of vertebral ring apophyses
                                                          • > 25% of disc circumference
                                                          • Typically extends < 3 mm beyond edge of apophyses

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Nonvascular Interventions

                                                                • Nuclear Medicine Findings

                                                                  • Other Modality Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Li Y et al: How should we grade lumbar disc herniation and nerve root compression? A systematic review. Clin Orthop Relat Res. 473(6):1896-902, 2015
                                                                                      2. Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
                                                                                      3. Hadjipavlou AG et al: The pathophysiology of disc degeneration: a critical review. J Bone Joint Surg Br. 90(10):1261-70, 2008
                                                                                      4. Walker J 3rd et al: Discography in practice: a clinical and historical review. Curr Rev Musculoskelet Med. 1(2):69-83, 2008
                                                                                      5. Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61, 2007
                                                                                      6. Urban JP et al: Pathophysiology of the intervertebral disc and the challenges for MRI. J Magn Reson Imaging. 25(2):419-32, 2007
                                                                                      7. Ido K et al: The validity of upright myelography for diagnosing lumbar disc herniation. Clin Neurol Neurosurg. 104(1):30-5, 2002
                                                                                      8. Lebkowski WJ et al: Degenerated lumbar intervertebral disc. A morphological study. Pol J Pathol. 53(2):83-6, 2002
                                                                                      9. Botwin KP et al: Role of weight-bearing flexion and extension myelography in evaluating the intervertebral disc. Am J Phys Med Rehabil. 80(4):289-95, 2001
                                                                                      10. Fredericson M et al: Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects. Spine J. 1(1):10-7, 2001
                                                                                      11. Adams MA et al: Mechanical initiation of intervertebral disc degeneration. Spine. 25(13):1625-36, 2000
                                                                                      12. Luoma K et al: Low back pain in relation to lumbar disc degeneration. Spine. 25(4):487-92, 2000
                                                                                      13. Milette PC et al: Differentiating lumbar disc protrusions, disc bulges, and discs with normal contour but abnormal signal intensity. Magnetic resonance imaging with discographic correlations. Spine. 24(1):44-53, 1999
                                                                                      14. Sambrook PN et al: Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum. 42(2):366-72, 1999
                                                                                      15. Harada A et al: Correlation between bone mineral density and intervertebral disc degeneration. Spine. 23(8):857-61; discussion 862, 1998
                                                                                      16. Cowan NC et al: The natural history of sciatica: a prospective radiological study. Clin Radiol. 46(1):7-12, 1992
                                                                                      17. Maezawa S et al: Pain provocation at lumbar discography as analyzed by computed tomography/discography. Spine. 17(11):1309-15, 1992
                                                                                      18. Ito S et al: An observation of ruptured annulus fibrosus in lumbar discs. J Spinal Disord. 4(4):462-6, 1991
                                                                                      19. Bernard TN Jr: Lumbar discography followed by computed tomography. Refining the diagnosis of low-back pain. Spine. 15(7):690-707, 1990
                                                                                      20. Tervonen O et al: Lumbar disc degeneration. Correlation between CT and CT/discography. Acta Radiol. 31(6):551-4, 1990
                                                                                      21. Kambin P et al: Annular protrusion: pathophysiology and roentgenographic appearance. Spine. 13(6):671-5, 1988
                                                                                      22. Sachs BL et al: Dallas discogram description. A new classification of CT/discography in low-back disorders. Spine. 12(3):287-94, 1987