Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 33

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"Protrusion, Bulge, Herniation, Extrusion, Sequestered, Fragmented…Your License Depends Upon Knowing the Difference!"

After reviewing 1000’s of narratives and speaking to just as many doctors nationwide, it is abundantly clear that disc diagnosis and definitions are still not clear to the majority of chiropractors nationwide. I am not going to take the time to teach you the different definitions in this space as it would not do anyone justice. It requires formal training and I do not want you to be shortchanged with just a few paragraphs. However, if you have a fragmented, sequestered or extruded disc finding of your patient, DO NOT TOUCH THEM. The above findings are all synonymous. It means a piece of disc material has broken away from the disc and grossly affects the spinal cord and can migrate, or fall to the bottom of the canal into the conus medullaris. This can cause a host of very bad things, and if left untreated, can exacerbate the negative findings along with potentially creating other permanent sequelae.


It is a contraindication to adjust a patient with fragmented, sequestered or extruded disc. Based upon outcome assessments of patient care and doctors, the doctor of chiropractic usually has the outcome of being sued and losing the case and often their license. I hope that is clear and blunt enough for you!


If your patient has a finding of fragmented, sequestered or extruded disc, an immediate surgical consultation with a neurosurgeon is warranted, not an orthopedic surgeon unless they are specifically a spine surgeon. It is my preference to work with a neurosurgeon, because many orthopedics hold themselves to be spine surgeons, although they do not have the advanced training a neurosurgeon does. There is no discussion or argument regardless of your philosophy about the referral or not treating them chiropractically.


If you do not know the difference between the definitions in the title or do not know how to recognize them on MRI, take the PI Bootcamp. It was created to make you expert at understanding disc pathology as well as a host of other findings. You will only win if you are the “best-of-the-best.”

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