Disc bulge, also known as disc protrusion or slipped disc, is a common condition that occurs when the outer fibrous ring of an intervertebral disc weakens and allows the soft inner material to bulge out beyond the margins of the disc. This can put pressure on the adjacent spinal nerve roots and cause pain, numbness, tingling and weakness in the area supplied by the compressed nerve. Determining the best treatment option depends on the severity of symptoms and how well conservative treatments work for an individual patient.
What causes a disc bulge?
The intervertebral discs are rubbery cushions located between the vertebrae that make up the spinal column. They act as shock absorbers and allow flexibility in the spine. Each disc has a tough outer layer called the annulus fibrosus and a soft gel-like center called the nucleus pulposus.
As we age, the intervertebral discs lose hydration and elasticity. The annulus becomes more brittle and is more easily torn with routine daily activities. When the annulus develops small tears or fissures, the inner nucleus can push outwards causing a disc bulge. This is more common in the lumbar spine and cervical spine which bear more weight and undergo more motion.
Factors that increase the risk of disc bulge include:
- Age – discs degenerate over time
- Obesity – excess weight puts more stress on the spine
- Improper lifting – using back instead of legs to lift heavy objects
- Repeated heavy lifting
- Driving for long periods
- Sedentary lifestyle
- Smoking – contributies to disc degeneration
- Genetic factors – some people inherit weaker connective tissue
A disc bulge alone may not cause any symptoms. However, if the bulging disc material presses on an adjacent nerve, it can cause inflammation and irritation leading to radicular pain and other symptoms.
Common symptoms of a disc bulge
Symptoms of a disc bulge depend on the location in the spine and which nerve roots are compressed or irritated. Common symptoms include:
- Back pain – ranges from mild to severe pain in the back
- Radiating pain – pain that radiates from the back into the buttocks and down the leg (sciatica)
- Numbness and tingling – in the area supplied by the compressed nerve
- Muscle weakness- if nerve impingement is severe
Cervical disc bulges in the neck can cause neck pain along with numbness, tingling and weakness in the shoulder, arm and hand. Lumbar disc bulges lower in the spine cause low back pain and radiating symptoms down the leg.
How is a disc bulge diagnosed?
Diagnosis of a disc bulge begins with a medical history and physical examination. The doctor will ask about symptoms, onset, severity, what makes symptoms worse or better, and whether there is any leg pain or neurological symptoms.
A neurological exam will assess strength, reflexes and sensation. This can help identify if a particular nerve is compressed.
Some common diagnostic tests used to evaluate a disc bulge include:
- X-ray – Can show changes in disc height and early spinal degeneration. May not show soft tissue like disc bulges well.
- MRI – Best test to visualize disc bulges and nerve compression. Shows soft tissues like discs and spinal cord in detail.
- CT scan – Good for assessing bony changes but less effective for visualizing disc issues or nerve impingement.
- Electromyography (EMG) – Measures nerve electrical signals and can confirm nerve root compression.
Once imaging and other test results confirm a disc bulge, the orthopedic spine surgeon will correlate findings with the patient’s symptoms to determine the optimal course of treatment.
Nonsurgical treatments for disc bulge
The initial treatment for a disc bulge is usually nonsurgical conservative management. This may include:
- Rest – Avoid strenuous activity and rest the back to allow symptoms to settle.
- Ice/heat – Apply ice packs to reduce inflammation or use heating pads to ease muscular back pain.
- Medications – Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants or prescription pain medications provide symptom relief.
- Physical therapy – Stretches, exercises and manual techniques help reduce pain and improve mobility.
- Epidural steroid injections – Steroid medication injected near the compressed nerve root reduces inflammation.
- Spinal decompression – Gentle stretching of the spine through traction devices or inversion therapy can relieve pressure.
These conservative treatments focus on managing the symptoms of a disc bulge. They may provide adequate relief for mild cases with intermittent symptoms. Patients are advised to restrict activities that aggravate symptoms.
The goal is to try nonsurgical options for at least 6-8 weeks to see if symptoms improve. If leg pain, numbness or weakness persists despite conservative care, surgical options may need to be considered.
Surgical treatments for a disc bulge
Surgery may be recommended for a disc bulge if conservative treatments do not provide sufficient relief and the condition continues to significantly impact quality of life. The main surgical options include:
- Microdiscectomy – Removes the portion of the disc compressing the nerve. Minimal access procedure with faster recovery.
- Laminectomy – Removes bone and tissue to decompress the nerve. Used for larger disc herniations.
- Discectomy – Removes the entire disc. Done when the disc is severely degenerated.
- Fusion – Joins two or more vertebrae together to stabilize the spine.
The specific surgery depends on factors like location of the disc bulge, type of disc material compressing the nerve, presence of instability or deformity, number of levels involved, surgeon expertise and patient characteristics.
Surgery has a high success rate for relieving the symptoms caused by a compressed nerve root. Recovery involves a period of activity restriction, pain management and physical therapy. Most patients experience significant improvement in leg pain and ability to function.
When is surgery recommended for disc bulge?
Surgery is generally considered if:
- Persistent nerve compression symptoms – leg pain, numbness, weakness
- Symptoms lasting over 2 months despite conservative treatment
- Significant functional impairment and disability
- Bowel/bladder dysfunction from nerve compression
- Unbearable radicular pain
- Progressive neurological deficits
- Spinal instability
Surgery aims to relieve pressure on the spinal nerve roots by removing the protruding disc material or bone compressing the nerves. This can provide rapid relief from debilitating leg pain, numbness and weakness.
The risks and extensive recovery period of surgery have to be weighed against the benefits for each individual patient.
What is the success rate of surgery for disc bulge?
Multiple studies show a high success rate for surgical treatment of a symptomatic disc bulge compressing a nerve root. One meta-analysis in 2016 looked at 63 studies on microdiscectomy for lumbar disc herniation. It found:
- At least 90% success rate for relieving leg pain
- Around 5% complication rate
- Only about 10% may require repeat surgery after 10 years
So in appropriately selected surgical candidates with persistent radicular symptoms, surgery provides effective relief in about 90% of patients. This allows them to return to normal activities and improve their quality of life.
However, surgery is not always successful. Risk factors for a poor outcome include:
- Multiple medical problems
- Significant spinal canal narrowing
- Obesity
- Depression/psychological issues
- Smoking
- Opioid use
- Workers compensation cases
- Ongoing litigation
Proper patient selection is key to ensure successful surgical outcomes. The risks and benefits must be carefully weighed before opting for surgery.
What are the risks of surgery for disc bulge?
All surgeries carry risks, both generalized risks of any operation as well as specific risks related to spine surgery. Potential risks include:
- Infection
- Bleeding
- Blood clots
- Nerve injury
- Paralysis
- CSF leak
- Need for fusion
- Hardware failure if fusion done
- Incomplete relief of symptoms
- Recurrence of disc herniation
- Chronic pain
There is also the possibility of an adverse reaction to anesthesia. Risks are minimized when surgery is done by an experienced neurosurgeon or orthopedic spine surgeon at a reputable hospital.
Recovery after surgery for disc bulge
Recovery depends on the type of surgery done for a disc bulge. It also varies considerably between individuals. Here is an overview of the general recovery process:
- Hospital stay – Microdiscectomy is outpatient surgery in many cases. More extensive procedures require 1-3 days hospitalization.
- Medications – Pain medications managed by the hospital and prescribed for home. Gradually reduced over 2-4 weeks.
- Activity – Strict activity restrictions after surgery. No bending, lifting or twisting. Short walks allowed. Gradual increase in activity after 4-6 weeks.
- Bracing – May require a back brace for support for 2-4 weeks.
- Physical therapy – Gentle exercises start about 2 weeks after surgery. Helps strengthen core and improve mobility.
- Time off work – Sedentary jobs may allow return to work within 2-4 weeks. Physically demanding jobs require a longer recovery period of 3-6 months.
- Pain relief – Leg pain generally resolves rapidly. Back pain and soreness may persist for 2-3 months.
Full recovery with return to strenuous activities usually takes about 6 months after surgery. Symptom recurrence is uncommon but may require additional treatment if it occurs.
Home care after surgery for disc bulge
Following discharge from the hospital, recovery continues at home. Proper self-care can facilitate healing. Recommendations include:
- Take medications as prescribed, especially pain medications at first
- Change dressings and monitor the incision site
- Avoid lifting, bending or straining per surgeon instructions
- Use ice and heat as needed for pain control
- Wear a back brace if advised
- Attend all follow-up appointments
- Contact surgeon if there are signs of infection – fever, increasing pain, redness/discharge from incision
- Perform gentle walking and light exercises as advised
- Focus on good posture and proper body mechanics
- Do not drive or return to work until surgeon approval
Adequate rest and limiting activity facilitates recovery. Support from family and friends can be helpful after returning home from surgery.
Conclusion
Disc bulge is a common spinal condition that can cause debilitating symptoms from nerve compression. Initial treatment focuses on nonsurgical options to manage symptoms. If conservative measures do not provide adequate relief after 6-8 weeks, surgical intervention may be warranted.
Discectomy and microdiscectomy surgery have a high success rate of around 90% for relieving leg pain and neurologic deficits from a symptomatic disc bulge. However, spine surgery does carry risks that need to be carefully weighed.
With appropriate patient selection and care from an experienced spine specialist, the vast majority of patients with a disc bulge compressing a nerve root experience substantial benefits from surgery and significant improvement in quality of life.