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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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Spinal Disc Problems

Back pain has many causes, many of which involve the discs in the spine. Discs are cushions that are located between each vertebrae that makes up the spine. Discs can deteriorate over time, possibly leading to several potential spinal disc problems. Normal Disc A normal, healthy disc provides cushioning between the bones, or vertebra, that make up the spine. A disc is round, but flattened at the top and bottom, and is flexible to provide shock absorption and act as connective tissue between vertebra. Each spinal disc is made up of a firmer collagen outer layer with a softer fiber and gelatinous center. Over time, loss of hydration may lead to discs becoming stiffer or more brittle, leading to potential problems. Degenerative Disc Disease (DDD) is not really a disease and is typically used to refer to the natural degeneration that occurs to discs over time. Loss of fluid causes discs to become thinner and stiffer. Degenerative Disc Disease may include inflammation within the inner portion of the disc or stiffening of the outer portion, resulting in micromotion instability and small cracks or tears. DDD does not always cause pain or other symptoms, but this condition may lead to the development of other spinal disc problems. Bulging Disc Due to weakening and thinning of the tough outer layer of the disc, the inner filling may press beyond its natural boundaries, forcing part of the outer layer to extend beyond its normal range, resulting in a protrusion of an area of the disc. Bulging discs typically have no symptoms, unless the protruding area presses on surrounding nerves. Herniated Disc If there are tiny cracks in the outer layer of the disc, pressure can allow some of the gelatinous fluid from the inner core to leak out of the disc and protrude into the spinal column. While it is possible that a herniated disc may have no symptoms, it is more likely because the protruding inner core is likely to press on surrounding nerves. Thinning Disc Thinning, or flattening, of spinal discs is a normal occurrence of DDD. Problems can occur if parts of the weakened disc break off and press on nerves or affect normal spinal movement. Thinning discs may allow bones in the spine to rub together, leading to pain and additional problems. Disc Degeneration with Osteophyte Formation As discs thin with DDD, less space is available between vertebrae. Osteophytes, or bone spurs, can develop to compensate for the thinning space. Osteophytes may cause no symptoms, or they may grow large enough to press on nerves. No matter what is causing your back pain, Become Pain Free has a medical specialist who will work to help you become pain-free. Make an appointment today by calling us today at (214) 396-3647 or toll-free at (888) 373-3720. The sooner you call, the quicker you can get back to living your life instead of living in pain.


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