FAQs on Bulging Disc and Treatment in Nashville

Bulging Disc

A bulging disc is not the same as a herniated disc. With a bulging disc, the disc simply bulges outside of the intervertebral space it usually occupies, which is between two vertebrae. With a herniated disc, a crack develops in the outer layer of the disc (called the annulus), and a small portion of the inner disc material (called the nucleus pulposus) ruptures out of the disc. A bulging disc is more common than a herniated disc, affecting around 50% of the adult population.

Are bulging discs painful?

Not all bulging discs are painful. With more than half of the adult population having these, only around 2-3% of people will report back pain and associated symptoms. Pain from a bulging disc often starts slowly but gradually worsens with time and during certain activities. A bulging disc only becomes serious when it causes narrowing of the spinal canal.

What are the symptoms of bulging disc?

If there is spinal canal narrowing and bone spurs on the vertebrae, a condition called spinal stenosis develops. If nerves are compressed, symptoms include:

  • Cervical spine bulging disc – Pain with neck movement, pain radiating into the upper arm, forearm, or fingers, and deep shoulder discomfort.
  • Thoracic spine bulging disc – Muscle weakness, tingling, and/or numbness of the legs, increased lower extremity reflexes, and changes in bowel or bladder function.
  • Lumbar spine bulging disc – Pain of the lower back, weakness, numbness, and/or tingling of the buttocks, legs, and foot, and changes in lower extremity reflexes.

What are the risk factors for bulging discs?

The risk factors for bulging disc include obesity, smoking, labor work with heaving lifting or prolonged sitting, and advancing age.

What are the treatment options for someone with a bulging disc?

A bulging disc is not always painful, nor does it mean you will need back surgery. The treatment of this condition depends on your medical history, current status, and symptoms. Options include:

  • Medications – Several medications are used for the pain and associated symptoms of a bulging disc. These include anti-inflammatory agents, prescription opiate medications, and certain antidepressants.
  • Physical therapy – To prevent or decrease functional limitations, physical therapy is recommended. The therapist teaches the patient strengthening exercises, to improve spine stability and flexibility. Based on the findings of a 2012 systematic review, there is evidence that supports the use of spinal manipulation by physical therapist in clinical practice.
  • Acupuncture – An ancient Chinese therapy used for the pain associated with bulging disc is acupuncture. The practitioner inserts small needles into the skin, which cause the body to release endorphins (natural pain relievers). In a recent study, acupuncture was found to be superior to control for various pain conditions.
  • Spinal decompression therapy – Using a specially designed table, this therapy gently decompresses the discs and elongates the spine. The table applies a distraction force, targeting the compressed disc, which is applied between episodes of relaxation.
  • Medial branch block (MBB) – To improve spinal mobility and alleviate pain, the doctor injects an anesthetic agent with or without a corticosteroid into the facet joint space near the bulging disc. The medication reduces the inflammation associated with the facet joints. In a clinical study, MBB was found to have an 85% efficacy rate.
  • Epidural steroid injection (ESI) – Performed under x-ray guidance to assure correct placement, the doctor injects a long-acting steroid into the epidural space, which is between the epidural layer and the spinal cord. In recent research studies, ESI was associated with a 90% success rate.
  • Intradiscal Injection – Performed for both diagnosis and treatment purposes, this procedure involves injecting an anesthetic agent (and possibly a corticosteroid) into the disc to block the pain. In addition to pain relief, research shows that intradiscal injections decreased the incidence and degree of ossification.
  • Percutaneous discectomy – With this procedure, a needle and catheter are guided through the skin into the affected disc using fluoroscopy. Once in position, the doctor uses a tiny suctioning device to remove the disc material and relieve the pressure associated with the bulging.

Resources

Kuczynski JJ, Schwieterman B, Columber K, et al. (2012). Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Int J Sports Phys Ther, 7(6): 647–662.

Mae T, Terada T, Haruyama N, et al. (2012). Intradiscal pressurized physiologic saline injection drastically reduced pain from cervical and lumbar disc herniation. J Pain, 13(4):S89.

McLain RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and leg pain: mechanism of action and efficacy. Spine Journal, 5:191-201.

Orthofracs (2013). Lumbar disc prolapse. Retrieved from:
http://www.orthofracs.com/adult/elective/spine/lumbar-disc-prolapse/epidemiology.html

Vikers, AJ, Cronin, AM, Maschino, AC, Lewith, G et al. (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med, 172(19), 1444-1453. doi: 10.1001/archinternmed.2012.3654.