What is a Bulging Disc?

A disc bulge means that at least 50% or more of the disc has pressure on it beyond the natural boundaries. This pressure is usually related to weakness or an increase in spinal load. The spinal conditions that cause the bulging disc, along with the disc’s pressure on the spinal nerves, can produce significant pain.

Bulging Disc Symptoms

The symptoms of a disc bulge involve compression on nerve roots of the neck and/or back. Over time, the muscles supplied by compressed nerves become weak, and pain occurs from compressed pathways. Symptoms of a bulging disc of the lower back include:

• Low back pain
• Leg numbness
• Leg weakness
• Leg tingling

Symptoms of a bulging disc of the neck region include:

• Neck pain
• Arm numbness
• Arm weakness
• Arm tingling

Causes of a Bulging Disc

The most common cause of a bulging disc is age. As a person ages, the spine starts to wear, causing the outer layers (annulus) of the disc to weaken. When this occurs, the disc bulges out of position along the spinal column, which causes pressure on surrounding nerves. In addition, discs bulge out of alignment from spinal degenerative disease that affects the vertebra, such as spinal stenosis and spondylolisthesis.

Disc Bulge Prevalence

Disc bulge prevalence is around 30% for young adults under age 35 years. However, by age 80 years, 84% of people have at least one bulging disc. Degenerative disc disease, often occurring in conjunction with a disc bulge, affects around 37% of young adults and 96% of those over 80 years of age.

Diagnosing Bulging Discs

When you see your primary care doctor for back pain, he/she will ask questions regarding your symptoms and perform a physical examination. If the symptoms point to a bulging disc, the doctor will likely order x-rays ad a magnetic resonance imaging scan (MRI). To rule out other causes of pain, blood work and a urinalysis could be ordered.

Treatment Options for Bulging Discs

The primary care specialist will refer you to a neurosurgeon for evaluation. If you have chronic back pain related to a bulging disc, you may need to see a pain management specialist. Options for treatment include:

• Medications – Treatment is focused on alleviating the symptoms associated with the bulging disc. Anti-inflammatory agents are used for pain and nerve inflammation (Ketoprofen, Naprosyn, Motrin). For muscle spasms, a muscle relaxant may be ordered (Flexiril, Zanaflex, Baclofen). Certain antidepressants (Amitriptyline and Nortriptyline) and anticonvulsant agents (Neurontin) are used for nerve-related pain.
• Epidural steroid injection (ESI) – This involves injecting the epidural space (outside the spinal cord) with a steroidal agent, with or without an anesthetic. This procedure is done at a surgical center under light sedation.
• Spinal decompression therapy – This is a type of traction applied to the spine to create a negative intradiscal pressure, which promotes repositioning of the bulging disc. In addition, decompression therapy lowers the pressure inside the disc, causing improved blood flow to the area.
• Lumbar endoscopic discectomy – After failing on conservative treatment, the doctor can perform surgery. This procedure involves use of a tiny endoscope (tube with a camera) being guided into the spinal region. The pieces of disc are removed that press on nerves during the procedure.
• Transcutaneous electrical nerve stimulation (TENS) – This device is worn outside the body. Electrodes are placed on the skin over the spinal cord region. Mild electrical current is transmitted from the battery-powered device, which interferes with pain signal transmission.

Resources

Brinjikii W, Luetmer PH, Comstock B, et al. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Amer J Neuroradiol, 36(4), 811-816.