Saturday, August 17, 2013

Diagnosis and Treatment for Bulging Discs Is Not Beyond Reach


A bulging disc is not necessarily a cause for panic as they are fairly common in both younger and older people. A bugling or protruding disc is usually see at high rates on MRIs in patients that suffer with back pain but are also found in patients that are not suffering from back pain. A recent study demonstrated that from a random sample of patients, a full 50% presented with positive disc pathology on MRI, although only a handful reported symptoms. Young and old, heavy or slim, those leading aggressively active lifestyles as well as sedentary ones, can be equally at risk.

Occasionally, disc bulges have a definable trigger or event; perhaps the patient performed a maneuver and felt (or heard) a "pop", followed by extreme pain and/or immobility. More often than not, however, the symptoms present gradually with the root cause having taken place at some time in the past. A series of "micro-traumas" will actually accumulate wear on the disc until it reaches a literal breaking point. There is a difference between a disc bulge and a disc herniation. Both can be diagnosed by looking at a lumbar MRI. A disc is made up of two parts and can be thought of as a jelly doughnut:

  • Nucleus- the inside part of the disc that is soft and compressible (the jelly)

  • Annulus- the tough outer portion that contains the nucleus (the dough)

With a disc bulge the material within a disc will remain intact with the annulus pushing out beyond its boundaries. In an herniation, the jelly (nucleus) actually extrudes through the annulus. This is typically considered more severe and a greater cause for concern.

The bulging or herniated disc can cause leg pain or foot pain, known as sciatica, when it presses against (impinges) the sciatic nerve. If nerve compression is left untreated, it can result in permanent leg pain and weakness.

When a disc bulges enough to cause narrowing of the spinal canal it is also considered to be a serious condition. If there are bone spurs present on the facet joints behind the bulging disc the combination of these spurs and the bulging of the disc may cause further narrowing of the spinal canal in that area.

The care of a patient with a lumbar bulging disc is far from standardized. To a certain extend the treatment of a patient's bulging disc should be more individualized. Common therapies for lumbar disc bulges include chiropractic, physical therapy, lumbar traction, inversion table therapy and lumbar epidural steroid injections. The goal of therapy is to decrease the disc bulge and its compressive effect on the nerve root. Treatment of a bulging disc will mainly be dependent on the degree of bulge and/or nerve compression (as evidenced by MRI or CT Scan), the length of time the patient has suffered with his or her symptoms and the severity of the related pain. Most treatments will start with six to twelve weeks of conservative treatment.

Non-surgical spinal decompression can provide pain relief from a disc bulge or disc herniation. Spinal Decompression creates a negative pressure or a vacuum inside the disc. This effect causes the bulge or herniation to "regress" or draw back from the nerve it may be pressing against and the increase in negative pressure also causes the flow of blood and nutrients back into the disc thus facilitating the body's natural healing response. An example of this intervention is the flexion-distraction therapy which is utilized to great effect by your chiropractor in Chicago. A decade's worth of study has demonstrated this pain-free, non-invasive regimen to be approximately 80% effective - eliminating the need for drugs or surgery at all.

The amount of time invested in conservative treatment needs to be addressed on an individual patient basis. No patient's symptoms will present alike. In the patients that are still able to lead a productive lifestyle with only minor aches and pains a longer conservative treatment would most likely be advised. Back surgery for bulging disc treatment should be the absolute last resort. For some patients the pain and loss of productivity is just too much to handle and after conservative treatments are explored for a shorter duration and there are no changes in the patient's symptoms, surgery to decompress the affected nerve is advised. Of course, patients that do not feel any recovery after six to twelve weeks of conservative care will often find themselves looking into the final bulging disc treatment option of surgery for their bulging disc.

NOTE: Any patient who has progressive neurological deficits, or develops the sudden onset of bowel or bladder dysfunction, should have an immediate surgical evaluation as these conditions may represent a surgical emergency. Fortunately, both of these conditions are very rare, and most surgery for a lumbar herniated disk is an elective procedure.

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