Diffuse Disc Bulge

Published: June 9, 2017
Last reviewed: June 15, 2017

This article explains the term diffuse disc bulge commonly found on the reports of magnetic resonance (MR) and computed tomography (CT) images of the spine.

What is the spinal disc?

The spinal or intervertebral discs are cartilages between the bones (vertebra) in the spine (Picture 1).

Spinal or intervertebral disc

Picture 1. A normal spinal or intervertebral disc

What is a disc bulge?

A disc bulge is a condition in which at least 25% (90°) of the disc’s circumference extends beyond its normal limits and the soft disc center does not break out through the outer fibrous ring (Picture 2[1].

Disc bulge - CT image

Picture 2. A CT image of a disc bulge (blue) (source: Radiopaedia, CC license)

What is a diffuse disc bulge?

The term diffuse disc bulge has no specific meaning but just describes a disc bulge in general. However, some doctors may use it instead of a broad-based herniation.

A disc bulge rarely causes any symptoms while a disc herniation can put pressure on the spinal nerve roots and cause pain in the neck, back, arm or leg. If your magnetic resonance (MR) or computed tomography (CT) image report mentions a diffuse disc bulge and it is not clear what it means, ask your doctor.

Details about the causes, symptoms, treatment and prevention of a bulging and herniated disc.

What is a diffuse annular bulge?

A diffuse annular disc bulge is just a long term for a disc bulge but some doctors use it when they want to emphasize that only the outer part of the disc called annulus fibrosus is involved in the bulge and there is no herniation.

What is a minimal or mild diffuse disc bulge?

In a minimal or mild disc bulge, the disc extends only slightly beyond its normal limits and rarely causes any problems.

What is a circumferential diffuse disc bulge?

A circumferential diffuse disc bulge extends over 50-100% of the disc’s circumference [1]. Note, that the severity of the symptoms tends to decrease with the percent of the disc’s circumference involved.

What is a posterior and posterolateral diffuse disc bulge?

A posterior or central diffuse disc bulge points backward to the spinal cord [1].

A posterolateral diffuse disc bulge points backward and laterally to the right or left spinal nerve root and may cause pain in an arm or leg.

What does the diffuse disc bulge L4-L5 or L5-S1 mean?

  • The disc L4-L5 is the one between the 4th and 5th lumbar vertebra in the lower back.
  • The disc L5-S1 is the one between the 5th lumbar and 1st sacral vertebra in the lower back.

If one of these discs bulges out, it may, rarely, cause pain in the lower back, buttock or leg.


  • References

      1. Fardon DF et al, 2014, 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  The Spine Journal

13 Responses to Diffuse Disc Bulge

  1. Varsha says:

    Hello Jan

    My MRI states that:

    L5-S1: there is a diffuse disc bulge with mild broad based left paracentral protrusion likely causing mild left lateral recess stenosis and mild right neuraforaminal stenosis.

    Can you please suggestion some treatment options for this case ?
    Is protrusion a herniation or disc bulge ?
    Can we do spinal decompression (traction) for this type of problem ?
    How much time does it take to heal a protrusion ?

    I am sorry for asking too many questions but I am actively looking for opinions.


    • Jan Modric says:

      In this case, protrusion means herniation, because the report says it likely causes right neural foraminal stenosis, which means narrowing of the opening in the bone through which the nerve exits the spinal cord. It is said that the stenosis is mild, so it is quite possible it will heal on its own in a reasonable time – in weeks to few months. Try to avoid physical work, especially bending or lifting anything heavier than few kg, and also prolonged sitting or driving. Walking is fine.

      It sounds possible that traction would provide some temporary symptoms relief but it may not shorten the healing time. It is a neurologist who can tell if there is any reason for any specific treatment.

  2. Suhail says:

    At L4-L5 level disc desiccation
    Diffuse circumferential disc bulge causing spinal canal and bilateral neural foraminal stenosis and compressing adjacent traversing and bilateral exiting nerve roots. Ligamentum flavum hypertrophy is seen adding to secondary canal stenosis

    • Jan Modric says:

      The disc between the vertebra 4 and 5 bulges out and presses upon the nerves that exit the spine on both sides. This may cause pain in the legs. It is an orthopedist or neurologist who can say what can be the optimal treatment.

  3. ss says:

    Age -39 years
    MRI findings>
    Opinion :Small posterocentral protrusion L4-5 disc
    Diffuse disc bulge and a small left foraminal / extraforaminal posterior protrusion L5-S1 disc

    Straightening of usual lumbar lordosis.The L-4-5 & L5-S1 discs are dessicated
    L4-5 disc shows a posterocentral protrusion that indents the ventral theca
    The L5-S1 disc shows a diffuse annular bulge and a small left foraminal/extraforaminal posterior protrusion that narrows the left l-5-s1 neural foramen

    visualised vertebrae shows normal height and marrow signal.No antero or posterolisthesis seen. The lower cord and conus are unremarkable. No pre or paravertebral collection seen.The facetal joints are unremarkable .

    problem faced by me is pain in lower back even while sitting and pain in legs and don’t feel comfortable in standing for longer durations. Job is getting affected as i am an engineer and need to lie down and access equipments at various odd/awkward postures and face difficulty in climbing stairs to reach at higher places.Already decided to switch job to one that requires less of physical fatigue and preferably to a office job.How good Is success rate of surgery? Can injections help in my case to cure ? or exercise? pl help in making me understand from any prospect?

    • Jan Modric says:

      The MRI report says there’s a protrusion of the discs between the L4 and L5, and L5 and S1 vertebra. Protrusion means herniation; you can read more here. Your symptoms sound like sciatica and are typical for this type of disc damage. Such herniation can often heal on its own (within months) without any treatment. An injection could temporary reduce lower back, but possibly not the leg pain. Surgery is quite effective but you may want to give the discs time to heal on their own.

      The main thing you can do on your own is to prevent further disc damage by avoiding:
      – lifting or carrying anything heavy (>5 kg) in the hands or carrying a heavy backpack
      – prolonged sitting or driving or standing
      – bending the back
      – quick moves, climbing ladders, sports and such

      Walking (>15 min) can reduce pain. Occasional changing position from standing to sitting can also help.

      Predominantly sitting (office) job is NOT an ideal job for a herniated disc.

  4. Teresa Poindexter says:

    MRI SPINE LUMBAR WO CONTRAST – DetailsPrinter friendly page–New window will open
    About This Test
    Study Result

    Lumbar spine degenerative changes are predominated by facet arthropathy at L4-L5 and mild bulging of the discs at L3-L4 and L4-L5.

    Lumbar spine degenerative findings are as fully detailed above, without evidence of significant canal stenosis or exiting nerve root compression at any level.

    VOICE DICTATED BY: Dr. Stetson Bickley

    ACCESSION NUMBER: 113280922

    INDICATION: MRI Lumbar eval radiculopathy Pain across the lower back goes into left hip

    COMPARISON: Lumbar spine x-rays 7/26/2017 lumbar spine MRI 10/1/2010

    TECHNIQUE: Multisequence, multiplanar MR images were obtained of the lumbar spine without the administration of intravenous contrast.

    FINDINGS: There are 5 lumbar vertebral bodies with vertebral body numbering performed with the designation of the last well formed intervertebral disc as L5-S1.

    Vertebral body heights are preserved. Chronic type degenerative endplate changes of the anterior superior corner of L3 L3, anterior superior corner of L4, and anterior superior corner of L5. Probable lipid poor hemangioma at L3.

    Level specific findings:

    T12-L1: No significant canal or foraminal stenosis.

    L1-L2: No significant degenerative change, neuroforaminal narrowing, or spinal canal stenosis.

    L2-L3: No significant degenerative change, neuroforaminal narrowing, or spinal canal stenosis.

    L3-L4: Minimal disc bulge. No significant canal or foraminal stenosis.

    L4-L5: Mild bilateral facet arthropathy. Circumferential disc bulge. No significant canal or foraminal stenosis.

    L5-S1: No significant degenerative change, neuroforaminal narrowing, or spinal canal stenosis.

    The visualized portions of the distal spinal cord are of normal caliber and signal characteristics.. The conus medullaris terminates at the L1 level. The cauda equina is unremarkable.

    Left renal cortical T2 hyperintensity is incompletely characterized but is probably a cyst.
    What does all this mean. I am having terrible pain in my lower back.

    • Jan Modric says:

      In short: there is no pinched nerves and only two discs are mildly bulged. There are some changes in “facet joints,” which are joints on each side of the vertebra that connect vertebra with each other.

      So, your pain might be due to “facet arthropathy,” which usually results from “wear and tear” of the spine.

      You also seem to have a cyst in your left kidney.

  5. ADITYA GAUTAM says:

    Straightning of lumber spine.
    Disc decsiccation at L5 S1 level.
    Mild disk bulge at L4 L5 level indicating thetical sac.
    Diffuse disc bulged at L5 S1

    • Jan Modric says:

      These descriptions say that two discs (L4-L5 and L5-S1) are bulging out, but it does not say that they would pinch any nerve, so it is not sure if they cause pain.

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