What is Bulging Disc Syndrome?
Bulging disc syndrome explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Bulging disc syndrome, also known as spinal disc herniation, is generally regarded as a degenerative condition in which the intervertebral disc herniates into the intervertebral space and places pressure on the spinal nerve causing a significant amount of pain. This pain is typically described as constant or persistent, which is not surprising given the fact that once the inner nucleus pulposus material of the intervertebral disc protrudes into the intervertebral space, it is not able to retract itself. Thus, the bulged disc remains there, pressed against or close to the spinal nerve.
The vertebral column, or the spine, is constructed of individual vertebrae that are stacked adjacent to each other. In between each individual vertebra are intervertebral discs. These discs have a protective outer layer called the annulus fibrosus. This layer is made of fibrocartilage that is tough and fibrous to hold in the contents. The inner structure of these intervertebral discs is more soft and pulpy. Known as the nucleus pulposus, this inside substance is made up of a mucoprotein gel, which gives it the consistency of jelly. The nucleus pulposus also contains loose annular fibers that help to maintain its shape and resistance.
The primary role of the intervertebral disc is to provide support to the individual bones comprising the vertebral column. In addition, intervertebral discs provide shock absorption for the spine, such that it buffers each vertebra bone from colliding with each other during daily activities, which would cause damage to the boney structures.
In general, bulging disc syndrome occurs most frequently among the vertebrae in the cervical area (the neck) or the lumbar area (lower back).
Causes of Bulging Disc Syndrome
While bulging disc syndrome can also be referred to as a slipped disc, this is not an accurate description of the condition. Not all cases of bulging disc syndrome are the result of wear and tear related to a degenerative process. Nonetheless, daily wear and tear on the structures that make up the vertebral column, over time, can cause the intervertebral discs to become dehydrated, gradually lose their ability to absorb shock, and become smaller in size. As a result, the tough and fibrous protective outer ring also becomes worn. Over time, this weakening of the annulus fibrosus increases the risk that the pulpy inner material could begin to press out and protrude (also described as herniating) into the area between the intervertebral disc and the surrounding bone, known as a bulging disc. The pain associated with bulging disc syndrome results from the bulging nucleus pulposus’ proximity to the spinal nerve. Pressure on these nerves can cause them to become irritated and swell.
Bulging disc syndrome can be associated with significant amounts of pain, particularly when the inner nucleus pulposus material bulges well into the intervertebral space and close to a spinal nerve, which is part of the network of nerves that generally run parallel to the spine. However, other individuals may experience a bulging disc with no accompanying symptoms. This depends largely on where the herniated disc is located and the degree of the herniation.
While in many instances, bulging disc syndrome is believed to be the result of a degenerative process that occurs as a person ages, a bulged disc can also occur spontaneously as the result of bending improperly. Typical daily movements do not cause much strain or place much pressure on the spine, as the intervertebral discs act to protect the spinal column. However, when the spine is forced to move sharply or lift something very heavy, there is significant pressure placed on the intervertebral discs to cushion the stress. As such, the protective outer coating of the intervertebral disc is at risk for tearing, or other damage, allowing the inner nucleus pulposus to bulge out.
Damage to the intervertebral discs in the cervical area can lead to chronic pain in the neck, head, and face. In some cases of bulging disc syndrome, shoulder pain is also reported. In terms of damage to the intervertebral discs of the lumbar region, chronic pain in the lower back, pelvis, buttocks, and even feet or toes can be reported.
When attempting to diagnose bulging disc syndrome, physicians typically gather a detailed account of the pain episode, along with a history of both the patient and his or her family. In many cases, imaging, such as magnetic resonance imaging (MRI) or fluoroscopy, may be used to confirm the diagnosis of bulging disc syndrome.
Treatment for Bulging Disc Syndrome
A number of treatment options are available for bulging disc syndrome. For instance, a highly effective option for managing neuropathic pain associated with a bulging disc is the use of epidural injections. This procedure involves the injection of an anesthetic medication, generally corticosteroids, into the area near the nerve that is primarily responsible for transmitting pain signals to the brain. Epidural injections for the management of pain associated with bulging disc syndrome would be inserted into any one of the cervical, lumbar, or sacral areas.
For instances of bulging disc syndrome in which the patient’s pain symptoms are not responsive to corticosteroid injections, a procedure called disc denervation may be considered. This technique can be done on an outpatient basis and does not require surgery. More specifically, a topical numbing agent is applied and a probe is inserted into the region surrounding the affected nerve. Then radiofrequency waves are delivered in an effort to reduce the nerve’s transmission of pain signals to the brain.
A final procedure available for the treatment of pain associated with bulging disc syndrome is a discectomy. This is a surgical procedure that involves removing the damaged and herniated disc. Indeed, this procedure is accompanied by a number of risks and should only be considered as a final option for the management of pain.
Bulging disc syndrome is regarded as a degenerative condition that affects the structure of the intervertebral discs within the spinal column. Specifically, over time these discs can become worn and weak, allowing the inner nucleus pulposus to protrude out into the intervertebral space, placing pressure on the spinal nerve.
Most cases of bulging disc syndrome occur within the neck and lumbar region. There are many treatment options available to manage the pain of a bulging disc. For instance, corticosteroid injections are available to reduce tissue inflammation and thereby treat the pain. However, should these interventions be ineffective, other procedures are available, such as disc decompression or denervation.
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