Bulging Disc Treatment in Philadelphia

A bulging disc occurs when a disc moves out of position in the spinal column. The disc protrudes into the region around the spine, but the inner material does not seep or leak out, as with a herniated disc.

How common are bulging discs?

As many as 55 percent of adults have one or more bulging discs, according to statistics. At any point during the life, 80 percent of the population have some type of back pain. The age range for those who have bulging discs is 20-60 years, and the mean onset is around 35 years of age.

What symptoms are associated with a bulging disc?

Because the outer covering of the disc is supplied by several nerves, a bulging disc is quite painful. With compression of a nerve, numbness and tingling down the extremity occurs. Back pain in the region of the disc bulge is common, which is usually worse with activity.

What causes a disc to bulge out of position?

The causes of disc bulging are aging, poor posture, injuries (falls/accidents), and constant and repetitive movements. The risk factors for this condition include:

  • Advancing age
  • Being tall
  • Eating unhealthy
  • Improper lifting
  • Not wearing a brace when lifting
  • Degenerative disc disease
  • Spinal arthritis
  • Smoking
  • Not exercising
  • Excessive weight

Where do bulging disc occur?

The majority of bulging discs occur in the lumbar (low back) spine. The most common site is at the very bottom of the lumbar spine.

How does the doctor diagnose a bulging disc?

If you have symptoms, the doctor will ask questions about your problem. In addition, the doctor will take a medical history and conduct a physical examination. If necessary, diagnostic tests are ordered, which include x-rays and magnetic resonance imaging (MRI).

How is a bulging disc treated?

The goal of treatment for anyone with back pain is to alleviate the symptoms and correct the underlying problem (if possible). Options include:

  • Medications – For the pain associated with a bulging disc, the pain specialist may prescribe a combination of medications. These include antidepressants, anticonvulsants, narcotic analgesics, and nonsteroidal anti-inflammatory drugs.
  • Facet joint injection (FJI) – Also called a nerve block, the doctor will inject the facet joint space with a long-acting anesthetic, using x-ray guidance to assure correct needle placement. This procedure has an 85% efficacy rate.
  • Radiofrequency ablation (RFA) – The doctor uses radiofrequency to destroy a portion of nerve root with the RFA procedure. A small needle with a special probe is placed near the affected nerves using x-ray guidance. A recent clinical study showed that 50 percent pain reduction.
  • Spinal decompression therapy – This involves use of a specially designed table to gently decompress the disc and lengthen the spinal column. The table exerts a slight force, and a computer controls the force and relaxation.
  • Epidural steroid injection (ESI) – This procedure involves an injection of a long-acting corticosteroid into the epidural space. This space lies near the spinal cord and nerves. A recent clinical study found that ESI has a 90% success rate.
  • Acupuncture – To stimulate the release of endorphins, restore energy flow through the body, and stimulate the body’s healing properties, acupuncture can be used. In a recent review of studies where acupuncture was used to treat chronic pain, this treatment was found to be superior to placebo.
  • Intradiscal injection – The doctor can inject the painful disc with a corticosteroid or special solution. A recent study found that intradiscal injection decreased incidence of ossification and relieved back pain.

Resources

Chou, R. (2010). Subacute and chronic low back pain: pharmacologic and noninterventional treatment. In: Basow, DS (Ed). Waltham, MA.

Ferrante FM, et al. (2004). Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Pain Medicine, 5(1):26–32. doi: 10.1111/j.1526-4637.2004.04009.

Mae T, Terada T, Haruyama N, et al. (2012). Intradiscal pressurized physiologic saline injection drastically reduced pain from cervical and lumbar disc herniation. J Pain, 13(4):S89.

McLain RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and leg pain: mechanism of action and efficacy. Spine Journal, 5:191-201.

Vikers, AJ, Cronin, AM, Maschino, AC, Lewith, G et al. (2012).Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med, 172(19), 1444-1453. doi: 10.1001/archinternmed.2012.3654.