A bulging disc, as the name suggests, is a disc bulge or compression that occurs in any of the vertebral discs along the spinal column from the neck to the lower back. This condition may affect the cervical spine (the neck portion), the thoracic spine (behind the chest) or the lumbar spine (lower back area).
Anatomy of the Vertebral Discs
Vertebral Discs are part of the vertebral column or the spine in the body. There are 33 vertebrae stacked one on top of the other in the spine and the discs lay in between the vertebrae, forming a perfect cushion to protect the spine and provide nerve protection.
The role of the discs is:
- To connect the vertebrae and form the spine
- To cushion and support the spine when weight is placed on it
- To help with movement
The vertebral discs in our body have a tough cartilage on the outside and a softer cartilage in the inside. It is easier to understand by thinking of them as caramel inside a chocolate.
When a disc bulges, it occupies more space than it does normally. It is the fibrous tough outer layer of cartilage that bulges. This layer is called the annulus fibrosus and the soft caramel-like gelatinous inner layer is called nucleus pulposus. When a disc bulges, it exerts force on the related nerves, causing nerve pain. The degree of disc bulge can vary considerably from mild to moderate and severe disc bulges.
The health of the vertebrae and discs is extremely important for several functions, the most important of which is movement.
Causes of Bulging Disc
A bulging disc is caused by either:
- A pre-existing weakness in the annulus (the tough outer layer), or
- A sudden increase in pressure within the disc that leads to the tearing of the annulus fibers
Disc injuries can be described in three headings;
- Accumulated microtrauma: repeated trauma over a long period of time can lead to disc injury, such as poor posture.
- Sudden unexpected pressure: Sudden force or pressure exerted on the intervertebral discs can lead to trauma, such as accidents. Such load can lead to the tearing of the annulus fibers.
- Genetic related: Injuries to the disc may also occur because the patients have a genetic predisposition. This usually happens in people who have lesser density of the elastin component of the fibers of the annulus. Other causative factors include, excess fat in the abdominal area, poor lower extremity strength, or it may occur in people who lift far heavier loads than their body capacity on a regular basis.
A physician may suspect a bulging disc when the patient experiences aggravated back pain, whether in the neck of lower extremities when:
- Bending forward
Serious symptoms needing emergency evaluation:
- Leg, arm or hand pain
- Pins and needles (in the legs, arms, face, shoulder, hand depending on the location of the disc)
- Weakness (leg, foot, shoulder, wrist, hand, elbow movements)
- Altered bower and bladder function
Any one of these symptoms or a combination of them may reveal a bulging disc.
A comprehensive history and physical examination is almost always the first step towards diagnosing the problem of a bulging disc. In addition to that, the doctor will suspect a bulging disc based on any specific injury or symptom behavior.
Diagnostic imaging is suggested for patients who have had no relief with conservative measures.
- MRI and CT scan imaging: These scans are considered to be the most accurate diagnostic tests to detect a disc injury and find signs of nerve compression.
- X-rays: An x-ray may be performed if the doctor suspects chronic disc injury such as disc narrowing and degenerative disc disease. However, x-rays cannot detect acute disc bulging.
Most minor as well as moderate bulging disc problems respond well to conservative treatment, and do not require surgery. The idea behind treating a bulging disc is to make it possible for the torn fibers of the annulus to heal. This is done by encouraging the fluid to return and remain in the disc centre. This helps the torn fibers remain close together, healing the annulus.
The following conservative treatment options usually show results within one month.
- Anti-inflammatory medication such as ibuprofen
- Steroid injections for inflammation
- Chiropractic traction
- Soft tissue massage
- Temporary back brace
- Deloading taping techniques
- Physical therapy for pain and improving stability
Most cases of bulging disc may not need surgery. However, when 4 or more weeks of conservative therapy fails to provide relief, doctors look at other options, and the most popular is discectomy.
- Discectomy: “Open” discectomy is an invasive surgery that is usually performed on patients who have failed all non-surgical treatments and who suffer from severe, disabling pain.
- Percutaneous Discectomy: Percutaneous means “through the skin.” This is a minimally-invasive procedure where a very small cut is made to remove the herniated disc material that is exerting pressure on the nerve root or the spinal cord.
Both discectomy and percutaneous discectomy offer excellent relief from pain and pressure, as well as treating disc herniation most effectively. The physician will decide if an open or percutaneous discectomy is the best option, based on the patient’s condition and need.
Laser discectomy is yet another form of discectomy that involves focusing a beam of light to dissolve a herniated disc. However, this is one of the more uncommon procedures, as it is not considered as safe as the others. There are other surgical treatments which are not considered as effective as discectomy.
Precautions for Bulging Disc
Even after the bulging disc has been treated either through conservative or invasive measures, it is important to maintain a healthy lifestyle. Patients that suffered a disabling pain due to the bulging disc may be advised physiotherapy for a few months, to get back the range of motion. Regular exercise, even if means just a simple walk around the block daily, helps improve strength.