BULGING DISC

Healthy vertebrae and discs are crucial to spinal movement, and discs provide a cushion between each of the 33 vertebrae in the spine. The vertebrae, stacked on top of each other with discs in between, provide nerve protection. Discs connect and form the spine, absorb weight placed on the spine, and to allow for movement. When discs are compressed, they become misshapen. Intervertebral discs are composed of a tough, fibrous outer layer called the annulus fibrosis. Nerve pain is caused when the disc is compressed or bulging.

The lower back is where most bulging discs occur, and less commonly, in the upper back and neck. More than half the people with bulging discs don’t experience any symptoms. For others, the pain can be mild to quite intense, and a physician may order a CT scan or MRI to diagnose the source of the pain. This kind of testing is suggested for people who’ve had  4-6 weeks of severe, or unmanageable, pain. The cause of the bulge, which could be disc herniation or degenerative disc disease, will be determined.
Most bulged discs will not require treatment, but for those that do, there are many options. Most physicians begin with conservative care, including the following:

• Over-the-counter anti-inflammatory/pain relief medications
• Short-term prescription pain relief from opiate medications
• Steroid injections for inflammation
• Physical therapy to help strengthen and improve stability
• Acupuncture
• Chiropractic traction
• Rest

In most cases, surgical treatment is generally not necessary. Once a physician can identify the underlying cause for the bulging disc, it can be treated with an open discectomy if other, more conservative, treatments have not worked.  .

Sources

1. Hsu, P.; et al. Lumbosacral radiculopathy: Pathophysiology, clinical features and diagnosis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011.
2. Fardon, D.; Milette, P. Nomenclature and Classification of Lumbar Disc Pathology: Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. Vol 26, E93-E113. 2001.
3. Milette, P. The Proper Terminology for Reporting Lumbar Intervertebral Disc Disorders. American Journal of Neuroradiology. Vol 18, 1859-1866. 1997.
4. van Rijn, J.; et al. Observer Variation in MRI Evaluation of Patients Suspected of Lumbar Disk Herniation. American Journal of Roentgenology. Vol 184, 299-303. 2004.
5. Wheeler, S.; et al. Approach to the diagnosis and evaluation of low back pain in adults. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2010.
6. Steiger, T.; et al. Diagnostic testing for low back pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011.
7. Robinson, J.; Kothari, M. Clinical features and diagnosis of cervical radiculopathy. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2010.
8. Robinson, J.; Kothari, M. Treatment of cervical radiculopathy. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2010.
9. Chou, R. Subacute and chronic low back pain: pharmacologic and noninterventional treatment. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2010.
10. North American Spine Society 2009: Lumbar (open) Microscopic Discectomy. Patient Handouts page. Available at Accessed April 15, 2011.
11. Buckwalter, J. A.. Aging and Degeneration of the Human Intervertebral Disc. Spine. Vol 20, 1307-1314. 1995.