Lumbar Bulging Disc

Intervertebral Disc: An intervertebral disc is a fibrocartilaginous structure found between the bodies of vertebra. These discs are located between each pair of vertebra in the lumbar spine. Think of this disc as being similar to a jelly doughnut: there are a series of outer fibrous rings that surround a softer center. The outer annular rings are thinnest posterior and lateral; most disc bulges occur at this location due to the weakness of the disc wall. The disc functions as a cushion, allows for movement, and serves as a cartilaginous joint between adjacent vertebrae.  What is a Bulging Disc? A bulging disc occurs when the outer walls of the intervertebral disc become weak, and the interior gelatinous substance pushes the wall out past its normal perimeter. It is possible to have a bulging disc without knowing it if it does not press on any of the nearby structures in the spine. However, if the bulge does put pressure on the nerves, ligaments or surrounding tissues symptoms can occur. The majority of bulging discs occur in the lumbar spine, at levels L4-L5 and L5-S1. A bulge in the lumbar spine can affect the sciatic nerve, creating a condition called sciatica.

  • Degeneration or general wear-and-tear, that breaks down the walls of the disc.
  • Repetitive bending and twisting motions especially in combination. These motions place the most stress on the outer fibrous rings.
  • Discs are most susceptible to injury in the sitting or bending position as the pressure on the disc is displaced to the front (anteriorly) pushing the contents of the disc posterior laterally toward the thinner and weaker annulus fibrosis.
  • A sudden fall or trauma, like a motor vehicle accident.
  • Genetic factors may contribute to the likelihood of intervertebral disc disease.

Bulging discs are common and most are not symptomatic. When a bulging disc occurs the symptoms will depend on the location of the bulge and what soft tissue structures are affected. Symptoms can vary from none at all or very mild if the disc is the only structure involved, or can be more severe. Other symptoms can include:

  • Pain in the back or radicular to the buttock into the leg down to the foot if the disc presses on the nerve root.
  • Sensory changes like numbness or tingling if the nerve is compromised.
  • Weakness can occur if the motor portion of the nerve is effected by the condition of the disc. In severe cases paralysis may even occur.
  • Diminished reflexes.
  • Muscle spasms and changes in posture in response to the injury.
  • Loss of motion including inability to bend or stand straight, and poor tolerance for sitting.
  • Standing and walking can be difficult if the bulge is severe. Often the patient will present with a shifted posture and have difficulty finding a comfortable position.
  • Please Note: A patient with a bulging disc may be symptom free if the disc does not press on a sensitive soft tissue structure.

Treatment of a bulging disc or injury will depend on the severity of the condition. When treating acute disc or back problems treatment options include:

  • Rest. Avoid the activities that produce the pain like bending, twisting, lifting and prolonged sitting.
  • Anti-inflammatory drugs and other pain medications.
  • Apply ice to the lumbar spine to help reduce pain and associated muscle spasms. Apply ice right away and then at intervals for about 20 minutes at a time. Do not apply directly to the skin.
  • An exercise regiment designed specifically to address the cause of the symptoms.
  • The use of a brace or other form of support may be necessary to reduce stress on the disc, muscles and lumbar spine.

In mild cases patients found that rest, ice and medication may be enough to reduce the pain. Physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.

If the problem persists, consult with your health care provider. Your physician should perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition and the best course of treatment.

In addition to performing a thorough examination your physician may order the following tests to make a more precise diagnosis:

  • X-ray to determine if there is any joint degeneration, fractures, bony malformations, arthritis, tumors or infections present.
  • MRI to determine any soft tissue involvement, including visualization of the discs, spinal cord and nerve roots.
  • CT scans which can give a cross section view of the spinal structures.
  • EMG, which is used to determine nerve involvement or damage.
  • Myelogram, which involves the injection of dye into the spinal column followed by an X-ray to visualize the position of and the pressure being applied to the discs.

Your physician may recommend several medication options individually or in combination to reduce the pain, inflammation and muscle spasm that may be associated with disc injuries.

  • Over the counter medications for mild to moderate pain.
  • If over the counter medications are not effective your physician may recommend stronger prescription pain medication.
  • Anti-inflammatory drugs or prescription NSAIDS (non-steroidal anti-inflammatory drugs) to reduce inflammation following acute injury.
  • Muscle relaxers to reduce acute muscle spasm.
  • Prescription medication designed specifically to reduce nerve damage and pain.

In the case of conditions that do not respond to conservative care, surgery may be recommended. If you continue to experience some of the following symptoms, your doctor may recommend you for a surgical procedure:

  • Increase in radiating or radicular pain
  • Pain or nerve damage that gets worse
  • The development of increased weakness
  • An increase in numbness or parasthesia
  • Loss of bowel and bladder control

Injections like facet injections, nerve blocks or an epidural. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.

  • Caudal Epidural Injections
  • Facet Joint Injections
  • Interlaminar Caudal Epidural Steroid Injections
  • Transforaminal Epidural Injections
  • Medial Branch Blocks
  • Selective Nerve Root Blocks

  • Endoscopic Decompression
  • Endoscopic Foraminotomy
  • Percutaneous Decompression
  • IDET Intradiscal Eletrothermal Therapy
  • Selective Endoscopic Discectomy

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