Bulging Discs
A bulging disc is a condition in which the inner portion of the intervertebral disc begins to protrude from the outer wall of the disc. This condition usually develops over time and can cause other disc degeneration conditions, such as spinal stenosis. When a disc bulges in the lower back it is called a lumbar bulging disc, when the disc bulges in the neck area it is called a cervical bulging disc. Intervertebral discs are the shock-absorbing structures between each vertebra. The discs have a thick outer layer surrounding a soft, gel-like center. A bulging disc may be a precursor to a herniated disc, or one which has partially or entirely broken through the outer wall of the intervertebral disc. Bulges can put pressure on the surrounding nerve roots, leading to pain that radiates down the back and other areas of the body depending on its location within the spinal column. If the symptoms are severe enough and have become chronic, surgery for a bulging disc may be required.
About 90 percent of bulging disc cases occur in the lower back, the most common bulging disc location sits between lumbar vertebrae L4/L5 and between vertebrae L5/S1. The pressure on the nerves caused by this bulges can put pressure on the sciatic nerve and lead to sciatica, causing leg pain and possible tingling, numbness, and weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg.
A Bulging vs. Herniated Disc
Bulging and herniated discs are sometimes interchangeable terms to define a condition that affects the intervertebral discs. However, they are several differences between these two conditions.
A bulging disc is not a broken disc, meaning the outer wall of the intervertebral disc remains intact but bulged. Whereas for a herniated disc, there has been a partial rupture or complete collapse of the outer wall of the intervertebral disc and the gel-like material inside the disc has spilled out causing pressure on the spinal cord or spinal nerves.
In the end, the primary difference between a bulging and a herniation comes down to whether they are contained or non-contained.
Contained Disc vs. Non-Contained Disc Disorders in the Back or Neck
Contained Discs: The disc has not broken through the outer wall of the intervertebral disc, which means the inner gel-like material remains contained.
Non-Contained Discs: The inner gel-like material has broken through the outer wall of the intervertebral disc. To complicate matters, sometimes fragments from the annulus (the outer disc wall) may break away from the parent disc and drift into the spinal canal.
Cervical Bulging Disc- Neck
A bulging disc in the cervical spine can occur at any of the vertebrae that compose the upper spine, described as C1 through C7. This condition occurs when pressure located in the inner portion of the cervical discs stretches out the outer layer of the intervertebral discs causing them to bulge. The C5-6 disc is the most common location of cervical spine disc bulges followed by C6-7 and then C4-5 bulges.
Cervical bulging discs can cause symptoms such as pain, numbness, tingling, and weakness that radiates through the neck, shoulders, arms, hands, and fingers. Cervical bulging discs can also lead to myelopathy, injury to the spinal cord, which can cause a group of symptoms such as difficulty walking, loss of fine motor skills, and heaviness in the legs.
Thoracic Bulging Disc- Mid Back
The thoracic spine spans from the collarbone to the end of the rib cage and consists of 12 vertebrae labeled T1-T12. Even though bulging disc is rare in this area, they can inflict symptoms such as pain in the upper back that radiates to the stomach and chest.
Most of the time, thoracic bulging disc symptoms are misdiagnosed with gastrointestinal, lungs, or heart problems. This is why it is so vital to promptly consult with a specialized physician to obtain an accurate diagnosis.
Lumbar Bulging Disc- Lower Back
Bulging discs in the lower back or lumbar spine can occur through vertebrae L1-L5, which span from the waist to the top of the hips. They are highly prevalent in this area and can lead to symptoms such as leg pain, numbness in legs, feet or toes, acute lower back pain, and other symptoms. Approximately 90% of bulging discs occur at L4-L5 and L5-S1, causing pain in the L5 or S1 nerve that radiates down the sciatic nerve. Symptoms of a bulging disc at these locations are described below: A bulging disc at lumbar segment 4 and 5 (L4-L5) usually causes L5 nerve impingement.
At the lumbar spine, symptoms will vary widely from the specific vertebrae being affected. L1 or L2 symptoms include pain in lower back and groin area and/or pain that radiate to upper front and inside of thigh. L3 or L4 symptoms include pain in lower back and /or pain that radiates to the quadriceps in the front of the thigh. L5 symptoms include pain in lower back and/or pain in the outside of lower leg, down to toes, which may include numbness, weakness and tingling.
Causes
A bulging disc is more common than you think, especially as the outer layer of the disc weakens with age. While age is one of the most common causes of a bulging disc, many activities could lead to the development of disc bulges.
Common causes of a bulged disc include:
- Trauma
- Genetics
- Poor posture
- Repetitive motions, often linked to your occupation
- Poor lifting techniques
- Contact sports
Other factors such as smoking, being overweight and consuming too much alcohol could also speed up the process of the deterioration of a disc’s outer layer.
Symptoms
Some cases of a bulging disc are asymptomatic until the bulge begins to press on a nerve. When the nerves are pinched or compressed, the symptoms will vary based on where the compressed nerve is located and the level of compression.
Cervical Disc Symptoms – A damaged disc in the cervical spine can cause pain that may radiate from the neck, down to the arms and fingers. People often experience symptoms such as pain, tingling, numbness and weakness. Pain that radiates down from the neck to the upper extremities is called radicular pain or radiculitis.
Thoracic Disc Symptoms – Symptoms in this area are often confined to the back, however they can also radiate along the nerve pathways and they may be confused for gastrointestinal issues, lung or heart problems, because in most cases signs experienced include pain the upper back that radiates to the stomach and chest.
Lumbar Disc Symptoms – A bulging disc in the lower back can cause pain in the hips, legs, buttocks, and feet. A bulging disc in the lower back can also lead to sciatica, which can cause debilitating pain and make it difficult to complete everyday tasks.
Diagnosis
Diagnosis for bulging discs starts with a complete family medical history assessment and a comprehensive physical examination. During the diagnosis for a bulging disc, physicians may inquire about the type of pain being experienced, possible related medical conditions, lifestyle habits, motor skills, and a full rundown of symptoms and what makes them worse to accurately diagnose a bulging disc.
Exams & Test
Once the initial diagnosis is completed, symptoms will be checked through different exams and tests to confirm the diagnosis; these tests might include:
- Neurological tests
- Range of motion tests
- Vital signs monitoring
- Gait monitoring
- Bulging disc MRI
- CT Scans
- X-Rays
- CT Myelogram
- Electromyography
Treatment
When compressing the spinal cord or pinching a nerve, surgery may be the best bulging disc treatment option if you have already completed conservative therapies, such as physical therapy, without resolution of the problem.
Non-Surgical Treatments
The first course of treatment for a bulging disc usually include a non-surgical approach that is a combination of anti inflammatory medication, exercise, and physical therapy. The most common non-surgical treatments used to treat bulging disc include:
- NSAIDs medications
- Steroid Injections
- Physical therapy
- Rest
- Chiropractic care
- Prescribed pain medications
Surgery for a bulging disc
When non-surgical treatment proves ineffective, or symptoms associated with a bulging disc are moderate to severe, surgery may be recommended. Spine surgery performed though a small incision can fix the problems caused by bulging discs without the risks associated with open spine surgery.
Dr. Alfred Bonati has perfected the Bonati Spine Procedures that are effective alternatives to traditional open spine surgery for bulging disc treatment. The surgery is performed on an outpatient basis, and thus eliminates hospital-associated inconveniences and helps patients get back to their lives faster. The Bonati Spine Institute has successfully performed thousands of surgeries to treat painful bulging discs and to allow our patients to live a life free of pain.
The Bonati Spine Procedures are an array of procedures that may include:
Prevention & Self Care
This condition is primarily a result of the natural degeneration of the spine. However, there are prevention tactics you can implement to reduce the stress placed on the spine and avoid chances of developing a bulging or herniated discs. Some prevention tactics include:
- Maintain a good posture
- Avoid improper lifting of pushing movements
- Practice regular stretching exercises
- Stop smoking
- Limit alcohol consumption
- Maintain a daily exercise routine
Also, during a bulging disc treatment, or after a bulging disc, spinal procedure self-care is crucial to maintain a healthy spine and prevent further complications. To care for a recovering bulging disc, implementing self-care practices can help, such as:
- Follow proper rest
- Take NSAIDs if suggested
- Avoid high-impact activities
- Continue physical therapy
- Use hot and cold therapy
- Avoid repetitive sitting, standing, or bending
The doctors and staff at The Bonati Spine Institute will provide each patient with a comprehensive overview of how each procedure works and is completed.
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