Overview of a Bulging Disc from Pain Clinics in NJ

A bulging disc results when an intervertebral disc protrudes into the spaces of the spinal column where the BackPainnerve roots and spinal cord are located. This bulging of the disc causes pain and can occur in the cervical spine (neck region), thoracic spine (mid-back area), or lumbar spine (low back). However, most bulging discs occur between the lumbar spine vertebrae, which are numbered L1 through L5. A bulging disc causes pain when a person sneezes, coughs, bends, lifts, or drives.

A bulging disc may show up on a diagnostic test even before the patient experiences pain. When the disc is not pressing on nerve roots or the cord of the spine, there is usually no pain. However, a simple sneeze can cause the disc to protrude on out, leading to back pain, numbness, and tingling sensations that radiate to other body regions, such as the arms or legs.

Causes of Bulging Disc

The disc between the vertebrae will bulge when they lose their elasticity and fluid content. Over time and with age, the vertebrae weaken and thin, and the intervertebral discs shrink and lose fluid. With heavy lifting or other strenuous activity, a disc can easily bulge out of place.herniated disc 3

With desiccation, a disc can lose its natural elastic recoil, and minor trauma increases pressure on the core of the disc, stretching and straining the outer fibrous ring. This makes the disc lose normal shape and prone to ballooning or bulging out of position. If the disc ruptures, the inner contents (nucleus pulposus) seeps out into the spinal column, causing serious pain from nerve root irritation.

Risk Factors for a Bulging Disc

Bulging disc are more common in people who are in the third and fourth decades of life, but they can affect anyone. While bulging disc are more common with age and degeneration, other factors increase their likelihood, such as:

  • Working in an occupation that requires bending, lifting, standing, and/or driving repetitively
  • Participating in athletics that are contact sports
  • Injury/trauma, such as a motor vehicle accident or bad fall
  • Smoking and alcohol consumption

Treatment for the Pain of a Bulging Disc

  • Epidural steroid injection (ESI) – To alleviate pain, the doctor can inject a steroid with or without an anesthetic into the epidural space. The epidural is the layer of tissue right outside the spinal cord. With this procedure, there is minimal discomfort and immediate pain relief.  In research studies, a 90% efficacy rate was associated with ESI.

 

  • Intradiscal injection – This involves the injection of a combination of a local anesthetic, steroid, and physiologic saline directly into the disc, which is done using x-ray guidance. This injection creates a pressure and to alleviate the pain associated with bulging disc.

 

  • Trigger point injection (TPI) – This involves the injection of a local anesthetic, and sometimes a corticosteroid, directly into the soft tissue or muscle along the spine near the bulging disc.Disc Injection

 

  • Regenerative therapy – Stem cells, collected from the bone marrow and adipose tissue, are transferred into the disc in an outpatient procedure. This allows the disc to essentially repair itself.

 

  • TENS unit – Transcutaneous electrical nerve stimulation involves the use of a small unit worn to deliver electrical impulses to the painful regions and along the nerve strands. These pulses prevent pain signals from reaching the brain and stimulate the body to produce endorphins (natural painkillers).

 

  • Spinal decompression therapy – This is a type of traction applied to the spine to create a negative pressure in the disc to reposition the bulging disc material. It also allows for a lower disc pressure that causes healing nutrients to go into the disc.

 

  • Physical therapy – The therapist teaches the patient certain exercises and stretching techniques that promote strength, flexibility, and increase motion.

 

  • Medications – Certain topical medications can provide pain relief when applied directly to the painful back region. Also, oral medicines include NSAIDS, painkillers, and an steroid (short-term use).

 

Resources

American Association of Neurological Surgeons (2014). Herniated disc. Retrieved from: http://www.aans.org/patient%20information/conditions%20and%20treatments/herniated%20disc.aspx

Mae T. Terada T, Haruyama N, et al. Intradiscal pressurized physiologic saline injection drastically reduced pain from cervical and lumbar disc herniation. J Pain. 2012;13(4):S89.

PubMed Health (2014). Herniated disc. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001478/