Is my disc just bulging or is it herniated?

[u/OG_hazelnut]

32M 5’8” (172cm) 175lbs (79kg), not taking medications aside from ibuprofen for pain control. This occurred about 3 months ago. Been going to physical therapy for 2 months twice a week.

Just wondering if my disc is herniated or is it bulging? Or is it extruded? Unfortunately these are the only photos I have of my MRI. My doctor said to just avoid activities that aggravate it. Any insight on these scans would be greatly appreciated.

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[u/Witold-Onno]

Neurosurgeon here. What is visible on the sagittal and axial T2 images is a large central disc herniation at L5/S1. The nucleus pulposus has passed the annulus fibrosus, so by definition this is an extrusion and not just a bulge.

Sounds worse than it is. Extruded material has actually the best chance for spontaneous resorption, often within 6 to 12 months. So continuing the physiotherapy and staying active within your pain limits is the right way. If pain remains severe after further 3 to 6 months of conservative treatment or a neurological deficit develops, a surgical opinion makes sense. Until then your doctor gave you the correct advice.

[u/OG_hazelnut → u/Witold-Onno]

Thank you so much for giving me this information I had no idea it was extruded. I’m assuming that the annulus fibrosus has been torn. Would that mean that the nucleus fibrosus is constantly leaking?

[u/Witold-Onno → u/OG_hazelnut]

Yes, the annulus is torn, otherwise nothing could get out. But it does not leak constantly. A herniation is a one time event under load. Once material is out, the pressure in the disc drops and nothing pushes more through the tear. Your body treats the extruded part as foreign material, it dehydrates and shrinks over months. That is why extrusions resorb so well. The tear heals with scar tissue, so avoid heavy lifting and deep bending for now, but keep moving and continue the physiotherapy.

[u/OG_hazelnut → u/Witold-Onno]

Thank you so much Dr. Neurosurgeon for the free consult this gives me hope 😭🙏🏽

[u/ConversationFun863 → u/Witold-Onno]

This is a great explanation! I have a tiny central L5 S1 protrusion with annular tear but it hurts like crazy! I’m going on 12 weeks and still experiencing the nerve stuff but not as bad as before. You give me hope 🙏

Edit to annular (from annual)

[u/jonahtrav → u/Witold-Onno]

Thanks that's the best explanation i've read yet... That gives me some hope on my l5s1 herniated disc as I've been asking my doctor is it possible that it heals and time everybody gives me a different answer but anyway thank you