Bulging Disc

The clinical term “bulging disc” refers to a common spine injury that occurs in the intervertebral disc of your spine. This condition can affect your lumbar spine (lower back), thoracic spine (upper and mid-back), or cervical spine (neck) ¹. A bulging disc, also known as a slipped disc or a protruding disc. Sometimes the disc bulge in a significant portion when the disc nucleus come out from the annulus and causes herniated disc. This condition can occur to anyone at any age, but higher prevalence occurs in the older population.

Generally, your spine consists of several vertebrae that comprise spinal discs in between. The spinal disc acts as shock absorbers and prevents damage to the spinal tissue and bone. This also helps to make the movement easier. Those discs comprise hard outer covering and liquid inside. Sometimes, these disc slips from their normal positioning that results in an outward swelling and leakage of the fluid materials. While left untreated, the symptoms will become worse.

The symptoms of bulging disc depend on the severity and the location of the occurrence. A bulging disc will not produce any pain until it reaches a certain severity level. Depending upon the severity, symptoms can develop rapidly or slowly.Typical symptoms of bulging disc include ²:

• Severe pain in the feet, thighs, lower spine, and buttocks
• Pain radiates towards the arms or legs
• Weakness in muscle and numbness in the fingers or hands
• Tingling in the fingers, hands, arms, neck or shoulders
• Changes in the bladder and bowel function
• Difficult walking or standing
• Feeling of impairment while lifting or holding things
• Paralysis (if spinal cord injured)

Pre-existing weakness in the annulus and a sudden increase in pressure through the disc can results bulging disc. Other potential causes of the bulging disc may include vehicle accident, poor posture that put stress on the spinal disc, torsion of the disc from repetitive work, repetitive forceful motions in sports, poor heavy lifting techniques, back injury from a severe fall, reduced lower limb strength, and driving or working for long periods of time. This condition affects almost 5 to 20 cases per 1000 adults annually in the United States ³. Data suggest that about 1-3 percent of patients have a lumbar bulging disc ¹.

How do Neurosurgeons Diagnose a Bulging Disc?

The initial diagnosis of a bulging disc includes physical examination to document the spinal deformity of patients, and neurologic examination to test muscle strength and sensation. Your doctor will perform clinical tests to confirm a spinal disc injury. Doctors may further confirm by the most accurate diagnostic tests that include X-ray imaging test, computed tomography (CT) scan, and magnetic resonance imaging (MRI) test ⁴.

How do Neurosurgeons Treat a Bulging Disc?

The major treatment protocols for patients with a bulging disc are conservative pain management and stabilization to prevent further injury. Depending on the condition of fracture and its stability, surgery may be necessary. Common treatment for bulging disc should include rest, physical therapy, exercises, and medications. These include ¹:

• Pain management: Medications like nonsteroidal anti-inflammatory drugs, pain relievers, muscle relaxants, or epidural steroid injections can help to relieve pain.
• Exercises: The practice of doing gentle yoga, swimming, walking, or hydrotherapy can be helpful in the long-run. You should avoid to shed excess weight and practice gentle exercises daily.
• Physical therapy: This includes strengthening the muscles and de-stress the spinal structures in the neck and back. Your physiotherapist may suggest transcutaneous electrical nerve stimulation (TENS) stretching exercises, acupuncture, and soft tissue massage to improve the condition ⁵.

About 70% to 85% of the patient’s symptoms diminish after non-operative treatment. In case of persistent pain of patients, surgery may be necessary to relieve the pressure. Consult with your doctor to select the best option for you.

References

1. Arts, M. P. et al. Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis. Med. (United States) 98, 1–9 (2019).
2. Rosińczuk, J. Analysis of the Causes of Lumbar Disc Herniation in Patients Treated Neurosurgical Due to it. J. Neurol. Neurosurg. Nurs. 4, 152–157 (2015).
3. Amin, R. M., Andrade, N. S. & Neuman, B. J. Lumbar Disc Herniation. Curr. Rev. Musculoskelet. Med. 10, 507–516 (2017).
4. Jordan, J., Konstantinou, K. & O’Dowd, J. Herniated lumbar disc. BMJ Clin. Evid. 2009, (2009).
5. Kanno, H., Aizawa, T., Hahimoto, K. & Itoi, E. Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes. Int. Orthop. 43, 917–922 (2019).