Dear Alice,

What is the difference between a slipped disk, a bulge in a lumbar disk, and a herniated disk?

I am (for the past two months) experiencing severe back pain which radiated down my left leg. My MRI results came back and the nurse from the office said I had "disk disease" and "degeneration" as well as a "slipped disk." The doctor called me later and told me I have a "bulge" and an "arthritic" spine condition.

I am trying to understand what the various terms mean (slipped vs. bulge vs. herniated). Could you tell me what the distinctions are?

Dear Reader,

Let's start at the top, or rather the back. Your spine is a column of thirty-three small bones called vertebrae. These bones create a protective tunnel for your spinal cord, a bundle of nerves that relay messages between the brain and the body. In between each vertebra is a small piece of disk-shaped cartilage. These "disks" act as a cushion and prevent the vertebrae from grinding against each other when you "do the Twist" or anything else that involves moving your back.

All of the strain and stress put on the back during a lifetime (lifting, bending, carrying the sofa up five flights of stairs) causes wear and tear on the disks and vertebrae. Disks also normally dehydrate — lose water content — over time. (This is actually one of the most important causes of disk degeneration.) This is the degenerative disk disease that your doctor mentioned. It's called degenerative, meaning that the breakdown of the disks takes place over time.

When disks are weakened, either from normal use over time or from injury or misuse, they can "slip" or move out of place, creating a slipped, bulged, herniated, or ruptured disk. All four terms mean the same thing — part of a disk is sticking out between the bony parts of the vertebrae. When a disk slips, bulges, herniates, or ruptures (remember they're all the same thing), the disk and the nerves around it can be compressed between vertebrae, causing pain, numbness, weakness, or difficulty moving the back and extremities.

Degenerative disk disease is a form of arthritis. This statement might be controversial, according to some. There's degenerative disk disease and degenerative osteoarthritis, but they're not necessarily considered the same. Other forms of arthritis also affect the spine, such as osteoarthritis of the spine, rheumatoid arthritis, and ankylosing spondylitis.

For more information about treatment and prevention of back pain and other problems related to disk disease, check out the following resources:

Regardless of the type of your back injury, or the language that your health care providers use, it's important to keep working with professionals to alleviate your symptoms and correct the problem. Best of luck!


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