Intervertebral disc are tough springy disc made up of protein, cartilage and water and set between the vertebrae in the back. These discs serve as shock absorbers, hold the vertebrae together as ligaments, and allow the spine to bend and rotate. Each disc has a nucleus which is a gelatinous center high in water content which is surrounded by a fibrous cartilage like substance. A disc herniation occurs when this gelatinous center forces its way through the fibrous ring and bulges causing pressure on nerves. Herniations can be contained within the disc, extruded outside it but attached, or free floating where pieces of the disc float in the canal putting pressure on nerves at times and not at others. There are 23 disc in the human spine, six in the neck, 12 in the mid or thoracic area and five in the lumbar or lower back area. Most pain issues occur in the lower back area which is where the highest level of weight bearing stress and movement occurs.
Diagnosis of herniated or bulging disc is made by X-ray, history, MRI and physical exam. Narrowing of the disc space can be seen on a common x-ray. We are an orthopedic surgeon center serving the greater Austin area and helping people overcome troubles with their back so that they can lead better lives.
Symptoms of herniated or bulging disc depend on the level of the herniation and which way the herniation is bulging. Interestingly, many people have bulging disc and have no pain at all while some people will have severe pain and no evidence of a disc bulging. Symptoms can include pain, numbness, tingling and weakness of extremities affected by the herniation. Symptoms are generally confined to one side although occasionally both sides may be affected. If the disc puts pressure on the blood vessels supplying the spinal cord or the cord itself neurological symptoms can progress rapidly necessitating immediate surgery but this is the exception rather than the rule. Most herniated disc can be treated at least initially with medical and non-surgical interventions and 60 to 80 % of the symptoms will resolve in the first four to six weeks
Treatment for herniated or bulging includes rest, exercise, medications such as anti-inflammatory like Advil and Naproxen, muscle relaxant and narcotic pain relief. Physical therapy to strengthen the core muscles around the spine can be helpful and may be advised by your doctor. Epidural steroid injections may be tried if these treatments do not work to decrease pain. Smoking decreases blood flow to the disc which has limited blood supply to begin with and can decrease healing and possibly increase the rate of degeneration. Aerobic exercise, if tolerated, can increase blood flow to the disc and help healing. Non-weight bearing exercise such as swimming and biking can be helpful. Maintaining a normal weight decreases the load on the disc and will help in healing.