Bulging/Herniated Discs - N. Y. Spinal Endoscopic

What Is A Bulging/Herniated Disc?

The term “bulging disc” is one of many terms used to describe the degree or extent of a herniated disc of the spine. The disc is a soft cushion between your vertebrae called an intervertebral disc. With age, you can strain your disc through injury or improper posture, which can weaken the disc’s integrity, causing it to lose its shape and bulge into the spinal canal. This bulging disc can push out and apply pressure to the spinal cord and spinal nerves, leading to painful symptoms including numbness, weakness, tingling and burning — or you may not have any symptoms at all. A herniated or bulging disc is the beginning cause of many other diagnosed conditions of the spine such as foraminal or spinal stenosis (narrowing of the spinal canal), sciatica, or radiculopathy. These conditions are all related to the space inside the spinal canal becoming narrow due to spinal arthritis, bone spurs, or disc herniated thus putting pressure on the spinal cord or nerves.

What Causes A Bulging/Herniated Disc?

Once a spinal disc has been traumatized via an injury to your neck or back the disc can begin a degenerative cascade where the outer part of the disc, annulus fibrosis begins to crack and weaken. The pressure from working, standing and everyday force we apply on our disc can cause the inner part of your disc, called the nucleus pulposus to bulge or herniate through the weakened annulus. Sometimes a bulging disc never becomes symptomatic and many people live with them daily. However, if the annulus continues to degenerate and crack the bulging disc can herniate, protrude, extrude or even in worst cases sequester.

Additional Causes Of Bulging/Herniated Disc

AGE

As we grow older, age-related changes occur to our spine. Many people grow old with no spinal pain or problems. However, many people suffer daily with pain due to degenerative changes in the disc and spinal column. A bulging disc in an older person has chemical alterations to the integrity and cushioning of the disc and it losses moisture and begins to weaken the tough outer annulus fibrosis much like a dry fragile sponge. As a result, disc may bulge or herniate and the disc can lose height effecting the vertebrae and facets causing other spinal issues. The ligaments supporting the vertebrae and spinal column can weaken as well, increasing the likelihood of a bulging disc.

OCCUPATIONAL HAZARD

Jobs that require heavy labor, repetitive movement, intense back supported lifting and poor back or lifting posture can lead to unwanted strains and weakening of the spinal disc and spinal column. The accumulative daily effect on the spine in poor work conditions can result in a degenerative effect on the spine and expose the worker to the possible bulging/herniated disc.

TRAUMATIC INJURY

These types of injuries could happened from a car accident, a heavy lifting strain, contact from physical sports or exercise. The repetitive motion or insult to the injury or poor exercise motion incorrectly, can start a degenerative disc cascade that can lead to a bulging disc. The blunt force from these injuries can cause symptomatic trauma to you back or neck.

POOR AND UNHEALTHY POSTURE

Bulging disc can also result from poor maintenance and awareness of your back or neck posture while resting, working or even playing. When you don’t think to protect against poor lifting and posture habits while at work, home or play you can expose yourself to unwanted strains that can directly weaken you spinal disc or add to age related degenerative disc problems. A good example of poor posture is lifting mainly with your low back instead of keeping your back straight and using your legs to lift safely.

FAMILY GENETICS

Unfortunately for some people they are genetically predetermined to develop degenerative disc or weak spinal disc. The inherited risks for degenerative disc disease makes a person a high risk for a bulging/herniated disc as well as multiple level disc disease.

There are three main types of bulging/herniated disc:

Contained Disc Herniation: The disc is considered contained or bulging if the inner nucleus is not pushed through the outer wall of the annulus.
Extruded Disc Herniation: The disc has ruptured and through the annulus wall entering the spinal canal. This type of extruded disc herniation is still intact with the spinal disc.
Sequestered Disc Herniation: The disc has ruptured, broken away from the disc and migrated into the spinal canal.

If you are experiencing painful symptoms in the neck, lower back or legs, it could be because of a lumbar herniated disc. Fortunately, there are effective treatment options available. Treatment for a herniated disc could include:

Bulging/Herniated Disc Symptoms

WHAT ARE THE SYMPTOMS OF A BULGING/HERNIATED DISC?

Bulging disc for many people are not symptomatic or if there are minor symptoms, people learn to live and adjust their lifestyle to cope with them. When bulging disc becomes severe and the symptoms become unbearable, the quality of life for those suffering becomes debilitating. The condition can cause significant loss of days at work, interfere with daily activities, sports and general leisure.

BULGING/HERNIATED DISC SYMPTOMS BY REGION OF THE SPINE

As a disc bulges, it can push out against the spinal cord or one of the spinal nerve roots of the spine that extend from your spinal cord out causing symptoms, depending on the region of the bulging disc, into your shoulders, arms, hands or hips, low back, legs and feet. The most common areas for bulging disc symptoms occur in the cervical and lumbar region. A thoracic bulging disc is not as common because the rib cage helps in spinal mobility. Symptoms of a bulging disc include:

Being able to describe these symptoms to your doctor is very helpful in diagnosing your problem.

CERVICAL (NECK/ARMS/HANDS) SYMPTOMS

A bulging disc or pinched nerve in the neck or cervical spine can produce an array of symptoms in your neck, shoulders, arms, and into your hands and fingers. Depending on where the bulging disc is, the symptoms can affect one side or both sides of your neck, arms and hands. Certain movements of your neck and arms such as rotating your neck or bending your neck backward, forward or sideways can send sharp pain or tingling sensation down one or both arms into the fingers. Some people with bulging nerves can experience spasms and tightness in the neck and shoulders with activity.

LUMBAR (LOW BACK/LEGS) SYMPTOMS

A bulging disc in the lower lumbar region typically compresses your spinal nerves. The spinal cord ends around the beginning of the lumbar region and becomes a bundle of nerves called the dura. Bulging disc compressing the exiting nerve can also affect the sciatic nerve, a nerve running from your hip down both sides of your legs. Once a bulging disc compresses the spinal or exiting nerve, mild, moderate of severe pain, numbness, tingling or weakness symptoms can be felt into the buttocks, thigh, calves, feet or toes depending on what level the bulging disc is and where it is located. Sometimes symptoms can be bilateral affecting both legs but often just one side. Sciatica symptoms are typically one side of your body but can develop in some people who have severe spinal or foraminal stenosis (narrowing of the spinal canal).

SEEKING TREATMENT FOR A BULGING/HERNIATED DISC

If the pain in your back makes you suspect that you may be struggling with a bulging disc, it’s imperative that you visit the expert team at the Spine Institute of North America. We have the skills to assess your condition and determine if you have a bulging disc. When you’re struggling with back pain, it’s comforting to know that our doctors specialize in pain management and can not only diagnose a bulging disc but also offer a comprehensive treatment plan suited to the individual needs of any patient. In our effort to promote conservative treatment options, we offer both non-operative pain management plans to help patients with bulging discs as well as least invasive surgical procedures.

What Are The Diagnosis And Treatment Options For A Bulging/Herniated Disc?

In most cases of a bulging disc, intervention and surgery are not necessary. Many patients with bulging disc often have their symptoms diminish within 4 – 6 weeks. Nonsurgical treatment initially works to relieve symptoms.

NON-OPERATIVE TREATMENT

INTERVENTIONAL SPINE PROCEDURES

Epidural Steroid Injections: are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, to confirm the correct affected level at which the pain originates from.
Percutaneous Discectomy: under fluoroscopic X-ray guidance a specialist can guide a device that can be inserted into the bulging disc to decompress the disc and take the pressure off of the nerve.

LEAST INVASIVE PROCEDURES

Endoscopic Discectomy: With an incision less than a ¼ inch, the surgeon can avoid all lamina bone resection and enter the spinal canal without disturbing or cutting muscle. The surgeon directly observes the herniated disc in a water (arthroscopy) environment with a surgical working channel endoscope coupled with a HD camera.

Recovery

Most patients can begin getting out of bed one hour after surgery and go home shortly afterwards. Activity is gradually increased and patients are typically able to return to work within a few days. There will probably be some pain after the procedure and is usually localized to the incision site. However, just because there is less or no pain, always consult your specialist or orthopedic surgeon before beginning any physical work.

At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.