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What does my MRI mean?

May 11, 2016 by Steven M. Gursten

Our attorneys explain what it means when our clients tell us they have a disc herniation or a bulging disc on an MRI after a car accident

MRI machine, image

Most doctors could use a little help on their bedside manner these days.  As appointment times shrink, what gets lost most is communication.  Little wonder that there are so many search results on why people should bring medical advocates with them to doctor appointments.

As an attorney who helps auto accident victims, I also get many of the same questions about the medical care my clients receive after a wreck. One thing that bewilders so many of my clients is that they’re sent for MRIs of the neck and back, and they’re told they have positive or abnormal findings of disc protrusions, bulges, or herniations, but with no explanation from the referring doctor as to what this even means.

Hopefully, today’s blog post will help to fill in some of the details on what your MRI results mean.

After an x-ray is done in a hospital emergency room, an MRI is often the next diagnostic imaging test that a medical doctor will order if a person is complaining of neck or back pain after a car accident. It’s also common for doctors to order an MRI of the brain if they suspect a person may have suffered a traumatic brain injury. MRI stands for magnetic resonance imaging, and it’s a technique that uses a magnetic field and radio waves to create detailed images of the organs, tissues and spinal discs within your body.

What can I expect during my MRI?

Think of an MRI machine as a large, tube-shaped magnet. When you lie inside an MRI machine, the magnetic field allows doctors to create cross-sectional MRI images — like slices in a loaf of bread – that can see things that an x-ray will miss. X-rays are very good for bones and fractures, but an MRI can show the spinal discs and whether a disc injury has occurred after a motor vehicle accident, which is a very common injury.

An MRI scan is painless. You will feel no sensations. However, you will hear the loud hum of the machine and often soft drum-like sounds when the system’s gradients are turned on and off. The MRI most often lasts between a half hour and an hour, but may take longer.

You can often listen to music.  I underwent an MRI of my neck and back a little over 20 years ago after I was hurt in a car accident myself, and I remember listening to Pink Floyd’s “Comfortably Numb” when I was in the machine (I wouldn’t recommend that).  It’s hard to say I’m thankful that someone ran a red light and hit my car as I was making a left-hand turn, but I do believe being injured in my own car accident at the start of my legal career has given me a special connection and empathy with my own clients. I once had to undergo the same MRIs, EMGs, physical therapy and IME appointments that they do, and I know how overwhelming and confusing it can feel.

Below I’ll discuss some of the most common MRI results after car accidents that our own attorneys see with our clients, and what these MRI findings mean.

What is a disc herniation on an MRI?

Think of a spinal disc as a jelly donut. Inside your spinal disc, there’s a much softer center area that’s encased and protected by a tougher exterior.  A herniated disc occurs when some of the softer “jelly-like” material pushes out through a tear in the tougher exterior part of the disc. It causes pain because this tear and the inner disc material then can irritate nearby nerves or impinge on your spinal cord. This can cause very severe pain, numbness, or weakness in an arm or leg. A disc herniation is a very bad injury that can be debilitating. As an attorney, I’ve compared it to touching a screwdriver to a live wire – it can cause very sharp, intense pain.

Sometimes a herniated disc is also called a slipped disc,  especially if you’re being seen by an older family practice doctor. Also, on an MRI finding, a radiologist may refer to a herniated disc as a ruptured disc, because the annulus (the tough, outer part of the disc) is ruptured and the nucleus pulposus (the soft, jelly interior) is sometimes jutting through the tear.

Here’s a good video I found that helps explain a herniated disc:

And here’s more information about a herniated disc in the neck or spinal cord.

What is a bulging disc on MRI?

A bulging disc is bulging out, so part of the spinal disc is pushing out past the space that a healthy spinal disc will normally occupy.

A disc bulge typically affects a large portion of the disc. Think of it like a hamburger that’s too big for its bun. The part of the disc that’s bulging out is the part that can often cause pain.

Here’s more information about a bulging disc in the neck or back.

Does a bulging disc cause pain?

Many doctors who are hired by insurance companies (often called IME or independent medical examiners) to perform one-time evaluations of people  injured in car accidents or in workers compensation cases will say that a bulging disc cannot cause pain.

That is utter nonsense.

The truth is that a bulging disc can cause terrible and disabling pain in some people, and it can be completely asymptomatic (not causing pain at all) in other people. It can also be considered a normal part of the aging process. Reggie White, one of the toughest defensive linemen in the history of football, was forced to retire because of bulging discs in his back, so I often wonder what would have happened to the insurance company doctor who told Reggie White that he wasn’t having back pain from a bulging disc.

As with so many things in medicine, there’s no black or white answer. Whether a disc bulge causes pain comes down to the history of the trauma itself (such as a car accident), the temporal relationship of the pain from the bulging disc to the trauma (when did symptoms first appear), and finally, clinical correlation by the treating doctor. This is the gold standard of medical causation evidence in personal injury law.

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