Disc Bulge 20 Months After Injury

One of the best imaging tools that physicians of any sort have at their disposal are MRIs. And MRI is great at showing soft tissue such as muscles, the spaces between joints, and other soft tissue, in addition to bony tissue as seen in X-rays. Often, however, because of how much can be seen with an MRI, an injury will be ignored if it doesn’t show up on an MRI. This is especially true in court cases over personal injuries or work injuries. The trouble with this way of viewing things is that it ignores that injuries are often a process, rather than an event and an image taken immediately isn’t nearly as helpful as one taken later.

Hairline fractures and most spinal fractures are already known to be notorious for not showing up within the first day or two after in injury on X-rays or MRIs. In the November 1993 issue of Spine magazine ran an article titled, “Traumatic Lumbar Disc Herniation a Case Report.” In this case study, they examined a patient who was struck by a car while driving a motor scooter and then hit her back on the pavement. The initial exam, X-rays, and MRI all showed no abnormal results. After two months an MRI showed a “very small” change in the L4-L5 disc of the low back. After 11 months another MRI showed a decrease in the disc height as well. It wasn’t until after about 20 months that another MRI was taken that the disc bulge was readily apparent.

This isn’t to say that the bulge was there and just didn’t show up later, as is the case of aforementioned fractures, but rather that an injury occurred, but developed into a much more problematic injury due to being untreated at first. It’s also interesting that even symptoms were minimal or absent at first, but certainly are issues once the disc fully bulges.

So remember, even if not in pain or pain subsides fairly quickly, it’s still important to get checked after an injury or accident in order to prevent a minor injury from becoming a larger injury.

--Joshua J. J. Jorde D.C.

The abstract, along with the rest of the first page of this fairly short case study, can be found here