A bulging disc, also known as a herniated disc, refers to when the outer fibers of an intervertebral disc are damaged, causing the disc’s inner, gelatinous core to protrude or bulge. This can put pressure on the spinal nerves, leading to pain, numbness, tingling, and weakness in the area served by the nerve. Surgery may be considered for bulging discs that do not improve with more conservative treatments. There are several surgical options available, each with their own pros and cons.
What causes a bulging disc?
The spine is made up of small bones called vertebrae that are separated and cushioned by gel-filled discs. Discs act as shock absorbers for the vertebrae above and below them. As we age, discs start to dry out and lose integrity. Activities like heavy lifting, twisting, and even just regular daily wear and tear can cause a disc to bulge or herniate. Genetics also play a role.
What are the symptoms of a bulging disc?
Symptoms of a bulging disc depend on its location in the spine and the severity of the bulge. Common symptoms include:
- Back or neck pain that may radiate into the arms, hands, legs or feet
- Numbness or tingling in the extremities
- Muscle weakness
- Loss of bladder or bowel control (very severe cases)
Some people with bulging discs have no symptoms at all. The condition is often found incidentally when getting imaging for an unrelated issue.
What are the nonsurgical treatment options?
Doctors generally try nonsurgical treatments first for bulging discs. Options may include:
- Pain medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and inflammation. Prescription medications may be given for more severe pain.
- Steroid injections: Cortisone injections can reduce swelling and inflammation around the bulging disc.
- Physical therapy: Stretching, strengthening exercises, massage, and other hands-on treatments can improve range of motion and reduce pain.
- Chiropractic adjustments: Can help take pressure off the bulging disc.
- Weight loss: If overweight, losing weight takes stress off the spine.
If symptoms persist after trying conservative measures for 6-8 weeks, surgery may be warranted.
When is surgery needed for a bulging disc?
Surgery is typically only considered if there is significant pain and impairment that persists despite nonsurgical treatment. Specific indications may include:
- Unbearable nerve pain in the arms or legs
- Numbness or weakness that is getting worse
- Loss of bowel or bladder control
- The disc is pushing on the spinal cord or nerve roots
Surgery aims to remove pressure on the nerves by either removing the bulging portion of the disc or removing the disc entirely.
What are the surgical options?
Common surgical options for bulging discs include:
Microdiscectomy
This is one of the most frequently performed surgeries for bulging discs in the lumbar spine. The surgeon makes a small incision and removes the portion of the disc that is protruding and irritating the nerve root using an operating microscope for magnification.
Laminectomy
A laminectomy removes the back portion of a vertebra (lamina) to create more space for the nerves. It is done when the bulging disc is pushing on the actual spinal cord.
Discectomy
In a discectomy, the entire intervertebral disc is removed. The vertebrae above and below are then fused together using bone grafts and/or metal devices.
Artificial disc replacement
The damaged disc is removed and replaced with an artificial implant made of metal and plastic. This maintains movement and flexibility better than fusion.
Foraminotomy
Foramina are openings on the sides of the vertebrae where nerves exit the spine. A foraminotomy enlarges these openings to relieve pressure on nerves.
What are the risks and complications of surgery?
As with any surgery, there are risks involved. Potential complications may include:
- Infection
- Bleeding
- Blood clots
- Nerve injury
- Worsening of symptoms
- Need for additional surgery
- CSF leak
Proper surgical technique can minimize these risks. Stopping smoking and optimizing other health conditions prior to surgery also helps reduce risk of complications.
How is recovery after surgery?
Recovery time depends on the specific surgery. Less invasive procedures like a microdiscectomy or foraminotomy may require only a one night hospital stay. More complex surgeries often require 2-4 days inpatient. Here are general recovery guidelines:
- 1-2 weeks: Rest at home and avoid strenuous activities
- 2-6 weeks: Begin light activity like walking
- 6-12 weeks: Resume daily activities but avoid lifting over 10-15 lbs
- 3-6 months: Fully recover strength and stamina
Physical therapy is a crucial part of rehab following surgery. PT will help restore mobility and build core strength to support the spine.
Which surgery is best for a bulging disc?
The optimal surgery depends on several factors, including:
- Location of the bulging disc
- Severity of symptoms
- Patient’s age and activity level
- Presence of other spine conditions
- Potential risks and benefits of each procedure
For example, a relatively young and active person may do better with artificial disc replacement rather than fusion. Older patients may opt for simpler surgeries with shorter recovery times.
In general, the least invasive options are tried first when possible. Laminectomy and discectomy tend to be reserved for more severe cases involving spinal cord compression. Consulting an experienced spine surgeon is crucial in determining the best surgical approach.
Conclusion
Surgery can provide significant pain relief and improved function in cases of bulging discs that do not respond to conservative treatment. While all surgical procedures carry some degree of risk, minimally invasive options like microdiscectomy and foraminotomy are usually the first line surgical treatments. More involved laminectomies, discectomies, and fusions may be warranted in certain circumstances. The optimal surgical approach depends on the individual patient’s symptoms and anatomy. An experienced spine specialist can provide personalized recommendations.
