Diffuse Disc Bulge

Author:
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

45 Responses to Diffuse Disc Bulge

  1. Rajesh says:

    Sir..My MRI LS SPINE REPORT SAYS…DISC DESICCATION WITH MILD DIFFUSE DISC BULGE NOTED AT LEVEL L5-S1 OF BILATERAL FJH(RIGHT>LEFT)…..DISC DESICCATION WITH DIFFUSE DISC BULGE AT LEVEL L4-L5 BILATERAL SEVERE NEURAL FORAMINA NARROWING AND LATERAL RECESS STENOSIS CAUSING NERVE ROOT COMPRESSION….AT L3-L4 LEVEL MILD LATERAL RECESS STENOSIS NEURAL FORAMINA NARROWING BILATERAL MILD LIGAMENTUM FLAVUM HYPERTROPHY……SIR PLEASE GUIDE ME..MY JOB IS PROLONGED SITTING…I M VERY DEPRESSED….PLZ HELP ME…

    • Jan Modric says:

      The reports says you have several bulging discs in the lumbar spine. Such discs may heal on their own with time (few months), but prolonged sitting is not optimal for that. You may want to get off the job for some time. You can also discuss with a doctor about surgery.

    • Rajesh says:

      Sir..Is surgery is only option in my case.?? Can it be cure by physio or medicine or any other advice…I will follow each n every instruction of you sir… Kindly advise me..I shall be very thankful..I don’t want to go for surgery Sir…Plz guide me sir..You are only hope for people like me who are suffering from the same..Thnx a lot.

      • Rajesh says:

        Sir..I forgot to tell you about my problem..I m suffering from extreme burning from my left hip to thigh area and pain in left hip.and burning has started in left side of back also..I m unable to sit… Please guide me with your extremely valuable advice..

        • Jan Modric says:

          Burning in the hip and pain in the back and leg can be all caused by pinched nerves due to bulging discs.

          I’m not saying surgery is the only option, but if nothing other helps, on the end, it can help. If you have a sitting job and you are not able to sit, then I strongly suggest you to discuss with your doctor to approve sick leave. Then it is recommended to stay active, in the sense of being in “active rest” – moving around, changing positions, walking, concentrating on some activity and relationships rather on pain, but avoiding any physical work, lifting objects and bending. By doing only this, the bulging discs can heal on their own without any physiotherapy or drugs. It may take several months for this to work, not only one month.

          As mentioned before, if the pain is unbearable, you can ask for analgesics or a steroid injection, but I’m not aware of any other drugs or herbal remedies that would cure the bulging discs. You may also want to find a good physiotherapist you can trust to show you some light stretching exercises – this needs to be discussed face to face, so I can’t recommend anything specific here.

  2. Fiona says:

    At T11-T12 seen on sagittal images only, there is a broad-based central disc
    protrusion that leads to mild canal stenosis.

    L3-L4: There is a broad-based central disc protrusion

    L2-L3: There is a diffuse disc bulge

    What does this mean

    • Fiona says:

      Also what is suggestion for symptoms of lower back pain radiating down the right leg with leg weakness in ordinance of those findings ?
      Thanks

    • Jan Modric says:

      It means, you have 3 bulging or herniated discs on the mentioned levels (in the lower thoracic and in the lumbar spine). The report does not say if there are any nerves pinched but the spinal canal (through which the spinal cord runs) is mildly narrowed – which may or may not cause any symptoms (in the legs?)

  3. Sam says:

    Thanks jan being kind and helpful. I will stick to your advise. So nice of you

  4. Sam says:

    Thanks jan for so much co-operation. I am asking so much questions but i am worried about this situation. I have rested for 1 month and but issue remains. What do you suggest on this issue?

    • Jan Modric says:

      By rest that can help to heal the discs it is usually meant avoiding lifting heavy objects and any heavier physical work in general, bending, prolonged sitting and driving. Rest here does not mean lying in bed or sitting all day. Walking can help relieve pain but other exercises may not help and may be harmful. Try to live as normally as possible. It may take few months for the pain to resolve and then additional few months for the discs to heal. You may want to read the article about a herniated disc.

  5. Sam says:

    I have an issue as i have back pain for last two months. MRI report says:
    At L5/S1, minimal diffuse disc bulge and tiny annular tears in lateral recesses.
    Minimal lateral recess/neuroforaminol stenoses seen . I am 26 year old. What are the complications in this situation? Whether special care is necessary?
    Please help me in this situation. I am very worried

    • Jan Modric says:

      There is a minimal bulge and tear in the disc between the 5th lumbar and 1st sacral vertebra. This is what likely causes pain in the lower back.

      The report says that the discs narrows the opening between the vertebra through which the root of the spinal nerve leaves the spinal cord, but it does not say if the nerve is pinched or not. If the nerve were pinched, you would likely have pain in the leg.

      Such disc damage can be caused by an injury or can be a part of degenerative disc disease which can occur in individuals as young as you are. The damage described in the report can heal on its own with relative rest.

  6. Nicola hayes says:

    MRI report says…. There is a slight disiccation and moderate annular bulging at L4/L5 with impingement of the anterior thecal sac and L5 transiting nerve root…. there is a prominent annular fissure at L4/L5…. I have very bad lower back pain when doing simple tasks like vacuuming or washing up or standing in same position also numb right ankle and shin

    • Jan Modric says:

      The disc L4/L5 is degenerated (desiccated) and there is a crack (fissure) in it. This very likely explains the pain in the lower back. I strongly suggest you to avoid lifting anything heavy, repetitive bending and prolonged sitting or driving until the pain resolves. Numb ankle and shin are likely due to a pinched nerve (L5) caused by the degenerated disc.

  7. BH says:

    Technique: Sagittal and axial T1WI, sagittal and axial T2WI, sagittal STIR images were taken through the lumbosacral spine. First degree retrolisthesis of L2 over L3 and L3 over L4. The vertebral body heights are preserved. No sign of vertebral body collapse. L2-L3 disk is desiccated, it shows central disk herniation indenting the anterior aspect of the thecal sac. No neural foramina compromise seen. L3-L4 disk is desiccated, it shows annular tear with central disk herniation indenting the anterior aspect of the thecal sac. No neural foraminal compromise seen. L4-L5 disk is desiccated, it shows annular tear with central disk protrusion. No neural foraminal compromise seen. L5-S1 disk is desiccated, it shows diffuse disk bulge indenting the anterior aspect of the thecal sac and compromises both lateral recesses. Normal dimensions of the spinal canal with no evidence of primary spinal canal stenosis. Normal MRI appearance of the conus medullaris and cauda equina. Cord ends opposite the L1. Normal marrow signal intensity of the scanned vertebrae. No remarkable paravertebral soft tissue abnormality. Opinion: First-degree retrolisthesis of L2 vertebra over L3 and L3 over L4. Multilevel degenerative disk changes most pronounced at the L5-S1.

    • Jan Modric says:

      The report says there are several degenerated (desiccated) discs in the lumbar spine but it appears they are not pressing upon the spinal nerves.

      • BH says:

        Many thanks Jan, so overall, is it a serious issue here or with some stretching exercises that might help to get back to normal. meanwhile, do you think to try to crack these areas which might help to get disks back?

        • Jan Modric says:

          The discs between the vertebra are made of cartilage and, in the center, of a soft substance that can bulge or herniate out due to repeated pressure. According to the report, there is a tear in the discs L3-L4 and L4-L5. The tears, bulging and herniation can heal on their own with time. You can read in this article about herniated disc that often the best therapy is rest and not exercise, “cracking” the area or physical therapy. By rest, I mean relative rest with avoiding lifting heavy objects, heavy physical work, bending, prolonged sitting or driving…not bed rest. Doctors usually encourage walking, though.

  8. Nahas says:

    Early degenerative disc diseases with mild diffuse annular bulge noted at L4 – L5 level causing bilateral lateral recess and neural foraminal narrowing.

    • Jan Modric says:

      This report says that the disc between the 4th and 5th lumbar vertebra is bulged and that it narrows the openings through which the nerve roots go out of the spinal cord. The report does not say if the disc is pinching the nerves, but it could.

      • Nahas says:

        Thanks Jan for replay. Still have back ache and some its radiate to legs. Its heal on its own (within months) without any treatment.

        • Nahas says:

          Thanks for your replay. This disc bulge heal their own? Need any other medication or physio ? How long take to heal ?

          • Jan Modric says:

            Yes, such mild damage can heal on its own without any drugs, physiotherapy or surgery. It may take few months to heal completely. Try to avoid lifting anything heavy, any physical work, sports and prolonged sitting or driving. I’m not aware of any helpful exercises but walking is usually encouraged for this problem.

          • Nahas says:

            thanks for your reply. i just write here my MRI full report. please review.
            lumbar lordosis maintained.
            early degenerative disc diseases in the form of dehydration and loss of disc height noted at multiple levels.
            mild diffuse annular bulge noted at L4-L5 level causing bilateral lateral recess and neural foraminal narrowing.
            rest of vertibral bodies, pedicles, laminae, spinous and transverse processes show normal MR morphology, alignment and signal pattern. The bony spinal canal appears normal at each level.
            the pre and para spinal regions do not showany demonstrable pathology.
            the facet joints appear normal.
            the conus medullaris and roots of cauda equina are normal in size, shape and signal pattern.
            impression: Early degenerative disc diseases with mild diffuse annular bulge noted at L4 – L5 level causing bilateral lateral recess and neural foraminal narrowing.
            now 4 weeks still have back pain like pin needle pain some times lower leg pain. i am afraid about it. its need more treatment? or rest ? now iam back in office. my job is sitting. its increase this condition? bulging? waiting for your reply. if need more rest i want to resign my job because i didn’t sick leave.

          • Jan Modric says:

            According to the symptoms, the disc L4/L5 is probably pinching the nerves that supply the legs. In general, the optimal treatment for such disc is rest: not rest in bed or constant sitting, but avoiding physical work, bending, carrying heavy objects and prolonged sitting or driving. Ideally, one could try frequently change his position: some walking, some sitting, some standing, and sleeping at night. Walking, for example at least 20 minutes once or few times a day, is the only exercise I believe it may help. I’m not sure if any physiotherapy or special exercises would help more than that. Painkillers by mouth or a steroid injection can help relieve the pain but you need to discuss this with a doctor.

            Sitting as such may not worsen the condition but prolonged sitting could. So, if possible, you can try to interrupt the sitting by having some 20 minute walking.

  9. Arun says:

    MRI says,

    -Central disk bulge at Level l2/l3 with moderate encroachment on the thesal sac
    -Small cental disk protrusion at level L5/S1 and there appears to be mild encroachment on the origin of S1 nerve roots
    -If this correlates to patient dermatomal distribution of symptoms, this site is amenable to CT guided steroid injection

    Kindly assist me with the above findings

    • Jan Modric says:

      The report says there is a mild disc protrusion (herniation) that possibly causes a compression of the S1 nerve root. The doctor then suggests a steroid injection, if these MRI findings correlate with your symptoms (which would be sciatic pain down the leg).

      • Arun says:

        Thanks for the response Jan. Will this disk herniation heal with out surgery. I am only 32 years old and bit worried with the risks involved with surgery.

        • Jan Modric says:

          The report says that the disc protrusion is small and the compression of the nerve is mild, which means there is a good chance the disc will heal on its own. I strongly suggest you to avoid anything what could worsen the disc protrusion, especially lifting heavy things and, if possible, prolonged sitting or driving.

  10. Brian says:

    Was wondering what my my MRI means and the severity of it. It reads as the followIMG

    Vertebrae: Focus of T1 and T2 hyperintense signal in the posterior L3 vertebral body consistent with a hemangioma. Fatty endplate marrow signal changes posteriorly at L2-3 secondary to underlying degenerative disc disease. No Loss of vertebral body height.

    Axial interbody analysis:
    L1-L2: loss of disc height and signal consistent with disc desiccation No central canal or neural foraminal stenosis.
    L2-L3: Marked loss of disc height and signal consistent with disc desiccation. Mild diffuse disc bulge resulting in minimal encroachment of bilateral neural foramen. There is mild flattening of the anterior thecal sac without significant central canal stenosis.
    L3-L4: Mild diffuse disc bulge and facet arthropathy. No central canal stenosis. There is mild right and mild-to-moderate left neural foraminal stenosis.
    L4-L5: Diffuse disc bulge with a small central disc protrusion. There is buckling of the ligamentum flavum and minimal facet arthropathy. No central canal stenosis. There is mild-to-moderate bilateral neural foraminal stenosis.

    • Jan Modric says:

      A hemangioma in L3 is a benign tumor in the third lumbar vertebra. Such tumor is not cancer (it does not spread) but may cause a local damage. A doctor may suggest further investigations to confirm diagnosis and tell the optimal treatment, which may involve a removal of the vertebra.

      The other part of the report mentions various features of degenerative disc disease:
      – “Disc desiccation,” = drying of the discs between the vertebra
      – “Facet arthropathy,” = changes in the small articles between the vertebra
      – Some “stenosis” (narrowing due to bulging disc), which may result in pinched nerves between the vertebra L2-L3, L3-L4 and L4-L5 (so this may be the most likely cause of eventual pain)
      – “Diffuse disc bulge” = disc bulge that affects a large part of the disc circumference but is milder than disc herniation
      – “Disc protrusion” = disc herniation

      So, apart from hemangioma, there are changes in 4 lumbar discs that may or may not be responsible for symptoms. These changes do not seem to be very severe and may heal on their own but a doctor can suggest to fix them during eventual surgery for a hemangioma.

  11. 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.

    Thanks
    Varsha

    • 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.

  12. 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.

  13. ss says:

    Age -39 years
    Male
    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.

  14. Teresa Poindexter says:

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

    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
    Narrative
    EXAMINATION: MRI LUMBAR SPINE 9/1/2017 2:45 PM

    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.

  15. 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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