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 Bulging/Herniated Disc

Overview

People often confuse a bulging disc with a herniated disc, as it is common to hear the two names being interchanged synonymously. Although these two issues are similar, one is actually different than the other. A bulging disc, (contained) is when one of the soft, jelly-like discs separating each individual vertebra in your spine is damaged and bulges, causing pressure on one of the tangent vertebra. This causes pressure on spinal nerves, sometimes causing severe pain or numbness throughout different parts of the body. A herniated disc (non-contained) is the result of a bulge that breaks through the thin layer of cartilage protecting the jelly-like disc, much like a water balloon. Bulging and herniated discs can happen anywhere in the spine, but most often occur in the lower back.

What Causes a Bulging Disc or Herniated Disc?

Bulging and herniated discs are caused by the deterioration or drying out of the disc over time. As we age, our discs wear down, causing them to allow less shock absorption and flexibility. This causes the thin layer of cartilage to weaken, enhancing the probability of a bulging or herniated disc.

What are the Symptoms of a Bulging Disc or Herniated Disc?

Depending on how the disc is pressing against, bulging and herniated discs can cause severe pain to no pain at all. Along with pain, a bulging and herniated disc can cause numbness. If the pain or numbness is in the buttocks or legs, then the damage is most likely in the lower spine. This is, more often than not, Sciatica, which is the most common symptom a bulging or herniated disc. If the symptoms are in the arms, shoulders, or neck, the bulging or herniated discs are more than likely in the upper spine and neck area. Although both bulging and herniated discs are likely to cause pain and numbness, many people that have had these disc disorders have experienced no symptoms at all.

How is a Bulging Disc or Herniated Disc Diagnosed?

Diagnosis of a bulging or herniated disc is typically done through a simple examination. However, if necessary, doctors may require a CT scan or MRI to determine the problem in the spine.

How is a Bulging Disc or Herniated Disc Treated?

Bulging and herniated discs rarely require invasive surgery. Typically, rest and relaxation is the best way to recover from severe cases of these disc disorders. Doctors usually recommend heating and cooling pads to reduce swelling and pain, and also a number of different daily exercises to help with flexibility and recovery. Also, there are a number of different medicines to help with the pain and swelling, so be sure to ask your doctor what is available and safe for you to take.

Terminology

Normal situation and spinal disc herniation in cervical vertebrae.

Some of the terms commonly used to describe the condition include herniated discprolapsed discruptured disc and slipped disc. Other phenomena that are closely related include disc protrusion, pinched nerves, sciatica, disc disease, disc degeneration, degenerative disc disease, and black disc.

The popular term slipped disc is a misnomer, as the intervertebral discs are tightly sandwiched between two vertebrae to which they are attached, and cannot actually "slip", or even get out of place. The disc is actually grown together with the adjacent vertebrae and can be squeezed, stretched and twisted, all in small degrees. It can also be torn, ripped, herniated, and degenerated, but it cannot "slip". Some authors consider that the term "slipped disc" is harmful, as it leads to an incorrect idea of what has occurred and thus of the likely outcome. However, one vertebral body can slip relative to an adjacent vertebral body. This is called spondylolisthesis and can damage the disc between the two vertebrae.

Signs and symptoms

Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting neck or low back pain that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet. Other symptoms may include sensory changes such as numbness, tingling, muscular weakness, paralysis, paresthesia, and affection of reflexes. If the herniated disc is in the lumbar region the patient may also experience sciatica due to irritation of one of the nerve roots of the sciatic nerve. Patients with L3 or L5 herniated disc (usually affecting the knee and leg) also have a high chance of experiencing decreased sexual performance ( erectile dysfunction ) due to the tissue involved with the penile muscle tissue. If the extruded nucleus pulposus material doesn't press on the p tissues or muscles, patients may not experience any reduced sexual function symptoms. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous or at least is continuous in a specific position of the body.

It is possible to have a herniated disc without any pain or noticeable symptoms, depending on its location. If the extruded nucleus pulposus material doesn't press on soft tissues or nerves, it may not cause any symptoms. A small-sample study examining the cervical spine in symptom-free volunteers has found focal disc protrusions in 50% of participants, which suggests that a considerable part of the population can have focal herniated discs in their cervical region that do not cause noticeable symptoms.

Typically, symptoms are experienced only on one side of the body. If the prolapse is very large and presses on the spinal cord or the cauda equina in the lumbar region, affection of both sides of the body may occur, often with serious consequences. Compression of the cauda equina can cause permanent nerve damage or paralysis. The nerve damage can result in loss of bowel and bladder control as well as sexual dysfunction. This disorder is called cauda equina syndrome.

Cause

Disc herniations can result from general wear and tear, such as when performing jobs that require constant sitting and squatting. However, herniations often result from jobs that require lifting. Traumatic injury to lumbar discs commonly occurs when lifting while bent at the waist, rather than lifting with the legs while the back is straight. Minor back pain and chronic back tiredness are indicators of general wear and tear that make one susceptible to herniation on the occurrence of a traumatic event, such as bending to pick up a pencil or falling. When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 17 psi (lying down) to over 300 psi (lifting with a rounded back).[citation needed]

Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (annulus fibrosis) on the posterior side (back side) of the disc. The combination of membrane thinning from stretching and increased internal pressure (200 to 300 psi) results in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, thus producing intense and usually disabling pain and other symptoms.[citation needed]

There is also a strong genetic component. Mutation in genes coding for proteins involved in the regulation of the extracellular matrix, such as MMP2 and THBS2, has been demonstrated to contribute to lumbar disc herniation.

Narrowed space between L5 and S1 vertebrae, indicating probable prolapsed intervertebral disc - a classic picture. MRI scan of cervical disc herniation between fifth and sixth cervical vertebral bodies. Note that herniation between sixth and seventh cervical vertebral bodies is most common. MRI scan of cervical disc herniation between sixth and seventh cervical vertebral bodies. MRI scan of large herniation (on the right) of the disc between the L4-L5 vertebrae. MRI Scan of lumbar disc herniation between fourth and fifth lumbar vertebral bodies.

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Failed Back Surgery Syndrome

Failed back surgery syndrome, commonly referred to as FBSS, occurs when a patient does not have a successful experience with spinal surgery intended to ease pain in the back, neck, hips, or legs. About 40 percent of people who go through open back surgery experience symptoms of failed back surgery. If you are one of those people, keep reading. You are not out of options. Causes of Failed Back Surgery Syndrome There can be many reasons why back surgery fails to ease pain or actually causes pain to get worse. Sometimes the original problem was incorrectly diagnosed, leading to unnecessary surgery or surgery in the wrong place on the spine. Other times, the surgeon misses a fragment of disc or bone which is left still putting pressure on the nerve. FBSS is certainly not always the fault of the doctor who performs the operation. Sometimes a patient develops a new spinal condition following surgery. Scar tissue from the original surgery can also lead to increased pain, as can damage to the nerves. Symptoms of Failed Back Surgery Syndrome Because there can be so many causes of FBSS, the symptoms can vary broadly as well. Some people find that their pain is reduced somewhat but not enough to make a meaningful difference in their quality of life. Other people say that their pain is not reduced but is actually worse after the failed surgery. Finally, some people do well for the first three to six months after surgery and then start to develop pain again. This is often caused by a new injury or by the formation of scar tissue. The site of the pain can vary as well. It may be located in the spine. Other people report pain in the neck or hips or shooting pain to the extremities. People with FBSS also frequently experience emotional pain such as frustration, depression, or anxiety. Treatments for Failed Back Surgery Syndrome Depending on the causes and symptoms of FBSS, there are many treatments available. They range from additional surgery to careful use of pain medications to exercise to electrical devices that reduce the transmission of pain signals. Here at Become Pain Free, we recognize that one treatment will not fit every patient. We will examine you carefully, run any necessary tests, and develop and individualized plan of care designed to ease your pain. Don't put off calling us. The longer pain is allowed to go untreated, the harder it is to control. Become Pain Free offers a diverse and comprehensive network of physicians whose sole purpose is to effectively treat your pain. If you are experiencing FBSS, don't suffer another minute. Call us today for an appointment. You can reach us at 214-396-3647 or at 888-373-3720. Pain does not have to control your life. We can help you control the pain.


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