Spinal disc pathology and its associated pain is described in many ways – as bulging, herniated, ruptured, slipped, or degenerative discs. The terms are often used interchangeably, contributing to the confusion. The most common conditions are bulging and herniated discs that develop in the spine. While they sound similar, they are significantly different from each other.
The spine, like all body organs and structures, is a miracle of engineering. The twenty-three intervertebral discs hold the spine in alignment, keep the vertebrae cushioned against each other, and stay pliable to keep the spine flexible. Although made to absorb shock and impact, poor posture, injury, repetitive strain, normal wear and tear, and aging can all cause a bulging or herniated disc.
What is a Spinal Disc?
The spinal discs separating each segment or vertebra of the spine are comparable to a jelly doughnut. The tough outer cartilage layer protects a soft inner layer called the nucleus pulposus – a mucoprotein gel containing suspended cartilage fibers. The oval-shaped discs function like shock absorbers between vertebrae and connect the ligaments holding them in place.
A bulging disc is the more common of the two conditions and is often the precursor to disc herniation.
With age, spinal discs may get dehydrated and less pliable. They can become compressed or flattened. As a result, the outer layer “bulges” out, even into the spinal canal. This is a normal part of the aging process. They are often painless, asymptomatic, and don’t need treatment if there are no other spinal stenosis issues.
Since there is no tear or rupture in the outer layer, bulging discs are medically described as ”contained.” If they impinge on a nerve root they cause various degrees of pain, depending on the extent of compression – from mild discomfort to numbness, tingling and weakness, to severe pain.
A bulging disc typically protrudes out and into the spinal column, however, the inner fluid does not leak and the disc itself remains intact.
Simple bodily functions like coughing, sneezing, bending, driving, and even just sitting may worsen the discomfort due to extra pressure on the nerve.
Herniated discs are ”non-contained,” indicating the presence of a tear or rupture. They often start with a “bulge”, until over time, the extra pressure on the outer cartilage causes a “herniation.”
In some cases, there is no open break but the outer wall thins and stretches out and the inner gel leaks out. The pain is due to compression of the nerve root, along with inflammation caused by the fluid leaking into the spinal canal.
Characteristics of a herniated disc:
- The disc is completely or partially broken
- The fluid leaks out into the spinal canal and nerves
- The fluid inflames the nerves, causing radiating pain
Both bulging and herniated discs have very similar causes. Many herniated discs start out as bulging discs that deteriorated due to one or a combination of reasons, such as:
- Improper posture
- Spinal injuries
- Repeated back or spinal strain
- Normal wear and tear
Since both conditions are so closely related, their symptoms are very similar. The main differences lie in the frequency and severity of symptoms. Sometimes bulging or herniated discs do not manifest any symptoms. Other times symptoms can be very painful:
- Pain varies depending on disc location
- Pain radiates to extremities
- Tingling and numbness
- Muscle weakness
- Limited range of motion
- In rare cases, a loss in bladder or bowel control
Because the disc material is contained in a bulging disc there is sometimes little or no nerve irritation or compression, and therefore no symptoms. These situations are much more common with herniated discs.
A physical examination, complete medical history and diagnostic testing with a specialist will confirm whether you have a bulging or a herniated disc.
Tests used to diagnose disc problems include:
- Neurological exam to evaluate reflexes and muscle strength
- X-ray, CT scan, or MRI to detect location of disc and nature of problem
- Discogram to detect affected disc
- Bone scan for underlying spinal conditions
- Blood tests for metabolic conditions causing back pain
After diagnosis, conservative treatment therapies are progressively applied. If these do not alleviate the pain, surgical options are applied as a last resort.
Treatment options include:
- Physical therapy
- Chiropractic adjustments
- Pain management
- Microdiscectomy – partial removal of herniated disc
- Spinal fusion – some vertebrae are surgically fused
Both bulging and herniated discs occur in the spine, and they may or may not cause pain. While they often have similar causes and symptoms, they also have significant differences:
- Herniated discs are non-contained; bulging discs are “contained.”
- Herniated discs are broken; bulging discs are whole.
- Herniated discs leak disc material; bulging discs project out.
- Herniated discs are more painful; bulging discs are more common.
- Herniation affects a small area; bulging affects a large surface of the disc.
Regardless of which condition is present, any issues with spinal discs can be very painful, and can have a direct effect on mobility. If you experience chronic back pain, contact Kamerlink Pain Institute for a complete evaluation and diagnosis. Call (561) 404-7667 today, and get the right treatment for your condition.bdsss