What Does My MRI Report Mean? Protrusion, Bulging, Extrusion
Spine MRI reports contain terms that can be confusing or worrying. Standard definitions help understand them [1].
Common terms
- Bulging: the disc extends slightly beyond its normal borders over a broad area; very common and often a normal age-related change
- Protrusion: a localised herniation whose base is wider than its outward part
- Extrusion: the herniated part is wider than its base; disc material has pushed further out
- Sequestration: a fragment separated from the disc
- Degeneration / desiccation: loss of water and height in the disc, part of ageing
- Foraminal stenosis: narrowing of the opening where the nerve root exits
Further reading: the guide “Lumbar Disc Herniation” and the articles C5-C6 Disc Herniation: Symptoms and Treatment and Neck Pain Radiating to the Shoulder: Causes and Treatment.
Findings without symptoms are common
Many people without any back pain have disc bulges and protrusions on MRI, and their frequency increases with age [2, 3]. An MRI finding is meaningful only when it matches the patient’s symptoms and examination.
What to do with your report
Share it with a physician who can examine you. Treatment decisions are based on symptoms, neurological findings and, if needed, electrodiagnostic tests, not on the report alone.
How an MRI report is organised
A typical report includes the technique, the findings level by level (for example L4-L5, L5-S1) and a conclusion. For each level, it describes the disc, the spinal canal and the foramina (the openings where nerve roots exit). Words such as “minimal”, “mild”, “moderate” and “severe” describe the size of a finding, not necessarily its clinical importance.
Other terms you may see
- Annular fissure (tear): a crack in the disc’s outer ring; often seen in people without pain
- Modic changes: signal changes in the bone next to a disc, linked to disc degeneration
- Spinal canal stenosis: narrowing of the central canal containing the nerves
- Nerve root contact or compression: the disc touches or pushes on a nerve root; its significance depends on whether your symptoms match that root
- Facet arthrosis: wear of the small joints at the back of the spine
- Spondylolisthesis: one vertebra slipping forward relative to the one below
Matching the report to your symptoms
Your doctor compares the level and side of a finding with the location of your pain, numbness or weakness. For example, an L5-S1 herniation on the left that touches the S1 root is relevant if you have pain down the back of the left leg to the sole, but much less so if your pain is only in the right buttock. When the picture is unclear, EMG (a test of nerve and muscle electrical activity) can help.
When repeat MRI is needed
Repeat imaging is not routinely needed if you are improving. It may be considered for new or worsening weakness, warning signs, or before an injection or surgery.
Red flags
Regardless of what the report says, seek emergency care for numbness in the saddle area, new problems controlling urine or stool, weakness in both legs or rapidly worsening weakness.
When to see your physical medicine and rehabilitation specialist
Seek assessment if pain is severe, keeps getting worse, wakes you at night or does not start to improve within a few weeks; if numbness, weakness or any warning sign appears; or if you are unsure what your test results mean. Your physical medicine and rehabilitation (PM&R) specialist, a doctor trained to diagnose and treat musculoskeletal and nerve problems without surgery, examines you, explains the findings and plans treatment together with the physiotherapist. Whether injections or other advanced treatments are suitable for you is decided by a PM&R specialist after examination. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, please consult a PM&R specialist near you.
To make the most of the consultation, it helps to bring:
- A short timeline of your symptoms and what makes them better or worse
- A list of your medicines and other health conditions
- Previous imaging (the images themselves, not only the reports), test results and treatment summaries
- Your questions and goals, such as returning to work, sport or a particular activity
Frequently asked questions
Does “protrusion” mean I need surgery? No. Most protrusions are treated without surgery.
Is extrusion worse? Not necessarily in terms of outcome; extruded herniations often resorb. See L5-S1 disc herniation.
My report says “degeneration”. Is my spine worn out? Disc degeneration is a common age-related finding, often present without pain. It does not mean your spine is fragile, and exercise is generally safe and helpful.
Should I get a second opinion on my MRI? It can be helpful when the report is confusing or when surgery has been suggested. Your physical medicine and rehabilitation specialist can review the images together with your examination.
Assessment and contact
You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.
Sources
- Fardon DF, et al. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014. PMID: 24768732
- Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015. PMID: 25430861
- Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994. PMID: 8208267