Disc Protrusion is a generic term for a disc disorder that sticks out past the margin of the vertebral endplates and encompasses both disc herniation and bulging. This term is best used when the data from the imaging studies is insufficient to discriminate between a herniated and bulging disc. Historically, when MRI was called NMR (nuclear magnetic resonance), almost 2 decades ago, the term protrusion was used exclusively. This was before further definitions of herniations were used to describe tears in the disc from trauma, and bulges were used to describe a degenerative process.
Herniation of the nucleus pulposus (HNP) through an annular defect causes focal protrusion of disk material beyond the margins of the adjacent vertebral end plate. (Any directional displacement of the disc is a herniation). In layman’s terms, a disc herniation occurs when the inside of the intervertebral disc (nucleus pulpous) tears its way through the outer portion of the disc (annulus fibrosis) and into the space where the delicate neural structures reside. This can only be caused from trauma.
Properly documenting CAUSALITY is critical in the initial management of a personal injury case. Was there an injury sustained or not? From a medical-legal perspective, at the beginning, nothing is more important.
Many trauma patients are first examined in the emergency room. When they are released are you they received a thorough evaluation and that when indicated, CAUSALITY was properly documented? The consensus on the national level is a resounding NO.
In a recent study by Schoenfeld, Bono, McGuire, Warholic, & Harris (2010), the authors inquire, “Thus, the question remains: does adding an MRI provide useful information that alters treatment when a CT scan reveals no evidence of injury” (p. 109)? They go on to state “In light of its ability to detect ligamentous, soft tissue, and osseous edema, many clinicians contend that the sensitivity of MRI for detecting injuries exceeds that of CT” (Schoenfeld et al, 2010, p. 111).
When a traumatically induced injury is examined, it is imperative that a complete and thorough examination be obtained by the doctor. This includes MRI which will show clinically significant injuries that are NOT diagnosed on a CT scan.
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