Orem Chiropractor - R. Ned McArthur, D.C. Discusses Back Pain & Disc Bulges

Do Disc Bulges Cause Back Pain?

Based on the common belief that a disc bulge causes back and leg pain I found the following article very interesting. “Prevalence of Disc Herniation in the Asymptomatic Population: A Compilation.”

The following table shows different researchers on the far left and the percentages at which they found false positives for different conditions. One of things that makes this study and this chart particularly interesting is that absolutely none of the people involved had low back pain or leg / sciatica pain.

To aid in your understanding of the table here are some definitions

Disc Protrusion (B)

Commonly called a disc bulge, a disc protrusion occurs with the spinal disc and the associated ligaments remain in tact, but form an out-pouching that can press against the nerves.

Disc Extrusion (C)

A disc extrusion occurs when the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the disc to squeeze out. Disc extrusions can occur with the ligaments in tact, or damaged.

Disc Sequestration (D)

A disc sequestration occurs when the center, gelatinous portion of the disc is not only squeezed out, but also separated from the main part of the disc.

False Positive Rates for Lumbar MRI
Investigation:	Disc Bulge	Disc Protrusion	Disc Extrusion	Disc Pathology (Bulge, Protrusion,extrusion, sequestration)	Root Deviation or Compression
Boden et al.		20%		NA
Jensen et al.	52%	27%	1%	64%
Boos et al.*		63%	13%		4%
Greenberg et al.	39%	18%		57%
Weishaupt et al.	24%	40%	18%		4%
Wood et al (11)*	53%	37%		63%
*	Because these investigation used a 'high risk' asymptomatic groups of people, i.e., people whose occupation required frequent heavy lifting, twisting, and bending; frequent exposure to vibration; and sedimentary occupations, I have EXCLUDED the results from the averaging below.
AVERAGES:	38%	29%	9.5%	60.5%	4%

Here's the bottom line: If we we’re to gather a group of middle-age folks (45 average age) who have NEVER had back pain before and perform MRI scans on them all, here's what we would find: 38% would have disc bulges, 29% would have disc protrusions, 10% would have disc extrusions, 0% would have disc sequestrations and 4% would have nerve root compression by the disc herniation. A more shocking statistic is that 60% of asymptomatic middle aged people would have findings of disc bulge or worse (protrusion, extrusion) on MRI!


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