TREATMENT FOR BULGING DISCS
Bulging discs are frequently seen on spinal magnetic resonance images, or MRIs. Whether due to trauma or age-related wear and tear, these specialized cushions situated between the bones of the spine often start to pooch out into the area occupied by sensitive spinal nerves. The severity of the bulge and the degree to which the disc encroaches upon the spinal nerves largely determine the severity of the related symptoms and the most appropriate course of treatment.
In a study published in 1994 in the “New England Journal of Medicine,” researchers identified disc bulges on 52 percent of MRIs of the lower backs of asymptomatic adults. Outside of research, it is unusual for an asymptomatic person to have an expensive MRI performed, but the high prevalence of disc bulges in the asymptomatic people in this study suggests that the condition may not always require treatment. At the very least, an otherwise healthy person who has been given a diagnosis of a mild disc bulge need not pursue aggressive treatment for the condition.
Besides discs, there are many other potential sources of pain in the back. The authors of the “New England Journal of Medicine” study warned that the presence of a disc bulge may be an incidental finding on an MRI and may not even be the cause of pain. A disc bulge discovered in a person with pain that remains localized to the back requires no additional treatment measures than those utilized to treat most other types of back pain. The most promising treatments, according to the Agency for Health Care Policy and Research, include nonsteroidal antiinflammatory medications, such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Naprosyn, Aleve), spinal manipulation, rest and traction.
Authors of a study published in 2010 in the “Indian Journal of Orthopaedics” determined that the presence and degree of disc bulging is less significant than the location of the bulge in terms of symptoms. Bulges that crowd the space where the spinal nerves must pass to exit the spinal column are much more likely to irritate or compress the nerves and cause pain. The resulting pain often radiates along the course of the sciatic nerve into the buttock, thigh or leg. Cases with radiating pain can often be successfully treated in the same way as those with just localized pain. In unresponsive cases, epidural steroid injections may be considered.
Severe disc bulges sometimes cause enough nerve compression that the result is not only localized or referred pain, but loss of function to the nerve and the parts served by the nerve. This is usually experienced as numbness or weakness in a leg, but can sometimes it may even affect bowel or bladder function. These cases often necessitate surgical treatment to relieve pressure on the nerve in order to avoid permanent deficits. Expert guidelines published in 2001 in the Journal of General Internal Medicine recommend reserving surgical treatment for cases with these types of deficits. In the absence of nerve deficits, surgery should only be considered after at least 4 to 6 weeks of failed conservative treatment.