What is a Bulging Disc?
A bulging disc occurs when a degenerative disc between 2 vertebral bodies becomes compressed and “bulges” away from its original position. Bulging disks differ from herniated disks in that a disc herniation occurs when softer interior disc material herniates through cracks in the outer disc layers, whereas a bulging disc occurs when the entire disc degenerates and becomes displaced to some degree from its original position. Bulging disks become a problem when they impinge upon the delicate neural elements such as the spinal cord, or nerve roots. Pain from a bulging disc can occur when the disc puts pressure on nerves or when the disc becomes chronically inflamed.
The discs between our vertebrae contain fluid that cushions the discs and helps hold them in place. As we age, we lose some of the fluid, which allows the discs to move out of position. While a bulging disc can occur at any point on the spine, they are more commonly seen in the lower back (lumbar region).
Bulging discs can also be caused by trauma or injury, such as in a car accident, by illness or infection, or by conditions like arthritis.
Symptoms of a Bulging Disc
The following symptoms may be indication that you have a bulging disc:
- Tingling in the legs or buttocks
- Arm or leg weakness
- Pain in the neck, arms, or lower back
- Numbness in the limbs
How is a bulging disc diagnosed?
When seeking the cause of the patient’s back or leg pain, Dr. John Lipani looks at different aspects of that pain. He’ll review your medical history and have you describe when the pain started, what you were doing when you first noticed it and what causes it to flare now, what the pain feels like (such as a burning sensation). Does it radiate into your arms or legs? Does one position seem to alleviate the pain, while another exacerbates it?
Then he’ll perform a physical examination. He’s assessing your nerve function and muscle strength. He’ll apply pressure and manipulate limbs to see if that triggers pain sensations. This is what he is assessing in your physical exam:
- Muscle strength — He’ll look for atrophy, wasting, or abnormal movement.
- Pain — He’ll check for pain both with motion and in response to touch, such as pressure applied to the lower back.
- Nerve function — He’ll test nerve function with a reflex hammer. Hot and cold stimuli may also be used to check nerve reactions.
He may order these diagnostic tests to confirm things:
- Imaging scans — CT scans and MRIs can show the spinal nerves, the discs, and how everything is aligned.
- Discogram — Dye is injected into the soft center of a disc or into several discs. The dye shows up on a CT scan or x-ray.
Where are bulging discs more common?
Although any spinal disc can bulge, 90 percent of bulging discs develop in the lumbar area of the back, described as the five vertebrae labeled L1 through L5. This is because this area of the spine carries most of the upper body’s weight. Discs in the cervical spine (the neck area) aren’t as prone to bulging.
What is the difference between a bulging disc and a herniated disc?
Our spinal discs provide the cushion between our vertebrae. As described above, they are quite soft and malleable in our youth, with a tough outer layer of cartilage surrounding a gel-like interior. As we age, our discs lose moisture and dry out. The cartilage stiffens. These changes can cause the outer layer of the disc to bulge out fairly evenly all the way around its circumference. A bulging disc usually encompasses at least half of the disc circumference. Where the disc pushes out beyond the edge of the vertebra, that’s where the problems can occur with nerve interaction.
A herniated disc usually starts as a bulging disc, but the pressure causes the outer layer of cartilage to crack (herniate). Or it can occur through a traumatic injury or incorrectly lifting a heavy object. This allows some of the soft inner cartilage to push out of the disc. Herniated discs can also sometimes be referred to as slipped discs or ruptured discs, but these monikers aren’t really accurate descriptions of what is happening.
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What are the risks involved with a bulging disc? What if I don’t have it treated?
Many people have a bulging spinal disc, but they have no symptoms and it doesn’t impact their life in any way. For others, however, the pressure that forces a disc to push outward brings it into instant contact with a nearby nerve root exiting the spine and they feel acute pain. As this continues, this becomes debilitating chronic pain.
Once a disc bulges outward it won’t return to its former state, contained within the usual boundaries of the vertebra. This doesn’t mean the only future option is surgery, however. Dr. Lipani first works through various conservative treatments; surgery is always the last option. For patients with only mild pain from their bulging disc, he may use only core strengthening exercises, postural training, anti-inflammatory medication, physical therapy, massage, even chiropractic treatment or braces. These lifestyle changes may be enough to eliminate the pain.
If, however, your bulging disc is causing a high level of chronic pain, the risks to you are a continued deterioration of your quality of life, as the pain forces you to move less and less. You’ll have to give up activities and sports you may have enjoyed your entire life. The pain from a compressed nerve can leave you feeling as if the scope of your life is now compressed, and your lack of mobility will likely begin to have other health impacts as well.
How will I know if surgery is necessary?
Despite our practice name, at Princeton Neurological Surgery Dr. Lipani views surgery as the last resort, opting for non-surgical treatments if possible. Surgery, however, can be necessary in cases where there is chronic, severe back pain, or when the patient is losing feeling or function in a body part such as the legs or feet. Surgery can be necessary in these cases to prevent permanent nerve damage.
How do I prepare for treatment for a bulging disc?
There isn’t any preparation required for any treatments Dr. Lipani may use other than surgery. If he has exhausted possible non-invasive treatment options, surgery may be the only remaining option for reducing or eliminating your chronic pain. If that becomes necessary, we will guide you through any preparation required.
Treatment and Surgery for Bulging Disc
Initial treatment for bulging discs usually includes ice packs or heating pads, resting the affected area, and pain medications like anti-inflammatories. Treatment often includes physical therapy, which will focus on exercises to strengthen your back.
In some cases, spinal injections of steroids may be recommended to relieve pain. This may be followed by physical therapy that aims to strengthen her core muscles.
In other cases, a bulging disc may require surgery. Surgical intervention may be performed in an effort to decompress the nerves or to remove the offending disc. If an entire disc is removed, an interbody fusion procedure must follow. In some cases, an artificial disc replacement may also be performed. Your healthcare team can determine the best option to treat your specific condition.
At Princeton Neurological Surgery, Dr. Lipani is a board-certified fellowship-trained spine surgeon in New Jersey who performs minimally invasive spine surgery as well as complex spinal procedures. Dr. Lipani is a specialist in the treatment for bulging discs and many other spinal conditions such as spinal stenosis, herniated discs, degenerative disc disease, low back pain, neck pain, spinal tumors, spinal cancer and more. Dr. Lipani treats patients from around the world, including New York, Pennsylvania, and New Jersey including locally from Princeton, New Brunswick, Hopewell, Pennington and communities throughout Somerset, Middlesex, Ocean, Burlington, Monmouth, Morris and Mercer Counties for bulging disc. Dr. Lipani offers image guided spine surgery approaches for bulging disc treatment, tailored to the needs of each patient. For state-of-the-art bulging disc treatment, call or email us to schedule a consultation at one of our convenient locations in Hamilton, Bridgewater, or Morristown, New Jersey!
What is recovery like after surgery for a bulging disc?
Dr. Lipani can use a variety of procedures depending upon your individual situation. Minimally invasive approaches are used if possible. These can include microdiscectomies and laminectomies, among others. These are nerve decompression surgeries, and the goal is to eliminate the compression on the nerve. This may include cutting away some of the bulging disc. It may involve removing the entire disc and fusing the two adjoining vertebrae. It may involve removing the back of the vertebra, the lamina, to create space for the nerve.
Open surgery compared to minimally invasive options involves a more difficult recovery. Once Dr. Lipani decides the best approach to your specific condition, he will discuss what you can expect for your procedure and your recovery.
Will I even need treatment for the bulging disc again in the future?
Success rates for decompression spine surgery are high with approximately 90 percent of patients experiencing good relief for their chronic back and leg pain. However, that doesn’t mean the pain cannot return, especially if there is an injury or excessive pressure to the area. Also, pain may come from a different bulging disc in the future.
Many patients needing spinal surgery don’t want to travel far from home to see a specialist in another state. With Dr. Lipani, you have bulging disc surgery options and never have to leave New Jersey. Dr. Lipani makes sure all his patients are well taken care of before and after neurosurgery, making them feel like part of the family.