Pain

Understanding the Differences Between a Bulging Disc and Herniated Disc?

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The human spinal column contains 33 vertebrae. Each vertebra has a rounded front, encases and protects the spinal cord. Discs are located between the vertebrae to provide cushioning and to aid with proper movement. These discs are comprised of an outer layer of cartilage and filled with a gel-like substance, the soft inner layer. Over time, discs can become worn and begin to dehydrate which leads to deterioration and pain.

A bulging disc occurs when a disc gets turned and pushes into the spinal canal. Bulging discs typically cause pain on one side of the body only. The location of a bulging disc will determine where the pain is experienced. A bulging disc in the upper vertebrae may cause neck, shoulder, chest, and/or arm pain. It can also cause numbness or weakness in the arms and hands. When a bulging disc occurs in the middle or lower areas of the spinal column, one may experience difficulty walking, loss of balance, tingling in the legs, and/or problems using the arms or hands.

A herniated or ruptured disc occurs when a small crack develops on the outer layer of a disc, usually due to wear and tear. When the soft inner layer starts to slowly leak from the crack in the disc, it is considered to be herniated. As the soft gel spills into the spinal canal, it often creates pressure on the nerve ends. If this occurs in the lumbar region, it can affect the sciatic nerve which causes pain in the legs and/or feet. The terms herniated or ruptured disc can be used interchangeably. Herniated discs can be caused by age, genetics, back injury, and/or sudden movement. Herniated discs occur more frequently in men than in women. Those who are 35 to 55 years of age tend to experience the highest rate of herniated discs.

Herniated discs, rather than bulging discs, are more likely to cause noticeable pain as the disc becomes inflamed and protrudes deeper into the spinal canal. The intrusion into the canal leads to irritation of the nerve roots. The nerve then becomes compressed resulting in chronic pain, if left untreated. Interestingly, many people that do not experience back pain are also diagnosed with herniated discs. The location of pain experienced is determined by the location of the herniated disc.

Bulging and/or herniated discs are diagnosed with a physical exam and imaging tests, including spinal x-rays, CT scans, and/or MRIs. The condition of the affected nerves can be checked with an electromyogram (EMG). Bulging discs are typically easier to treat than herniated discs. Treatment is individualized depending on the location of the disc, the severity of the pain, and symptoms experienced.

Rest and anti-inflammatory medications may be enough to treat a bulging disc. A physician may prescribe a muscle relaxer or narcotic pain reliever in more serious cases of pain. Furthermore, physical therapy can help relieve pressure on the nerve resulting in less pain. Cortisone injections into the affected disc may also provide long-term relief.

A herniated disc may improve on its own, but often requires a few weeks of treatment. Self care options include: avoiding exercise and lifting, alternating ice and heat on the affected area, and a short period of bed rest. As with a bulging disc, over-the-counter anti-inflammatory medications often help ease the pain while reducing swelling of the affected nerves. These medications should not be used longer than 10 days without prior approval from a physician, due to the increased risk of bleeding, heart or kidney problems. Depending on the severity of pain, a physician may also prescribe a narcotic pain reliever and/or muscle relaxers for a short period of time. Physical therapist can provide muscle strengthening exercises to help support the back. An epidural injection of steroid medication may also be required to ease the pain. Oftentimes, more than one injection is needed for maximum pain relief.

Surgery is typically the last resort for both bulging and herniated discs. It is a viable option if an individual's pain level is not improving or the individual is having increasing difficulty with standing, walking or control of the bowels and/or bladder. A surgeon will be able to determine, depending on the severity of symptoms, if surgery is needed.

Surgical procedures include a discectomy (removing the damaged disc), laminotomy (removing a piece of bone from the vertebra in order to alleviate pressure from the spinal canal), spinal fusion (fusing together two vertebra on each side of the damaged disc to stop the bones from moving), and artificial disc surgery (replacing the damaged disc with one made of plastic or metal).

There are many ways to protect the discs of the spinal column from injury. These include, but are not limited to, good posture, limiting standing for long periods of time, squatting and using the legs and knees rather than curving the back to lift objects, maintaining a healthy weight, and avoiding smoking.

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