Bulging Disc Treatment & Surgery Options
A bulging spinal disc is a contained disc, meaning that the nucleus puplosus has not broken through the tough outer layer (annulus fibrosus) of the disc.
When a disc herniates, the outer wall of the disc is either partially or completely broken. This affects the viscoelastic properties of the disc and can cause the disc to bulge out from its position between each vertebra and create nerve pressure on one or more nerves.
When a bulging disc has been identified as the source of neck pain, lower back pain, or pain radiating to the extremities, doctors often explore conservative treatment options first. These non-surgical options may include:
• Anti-inflammatory pain medications, either over-the-counter or prescription
• Epidural cortisone injections
• Physical therapy
• Lifestyle changes, including losing weight and quitting smoking
However, when conservative treatments fail to offer lasting relief, spine surgery may be required.
Treatment Goals for Bulging Discs
Once diagnosed, your physician will build a treatment protocol for relieving your pain, restoring your range of motion, and improving your overall health. The plan will take into consideration the severity of your bulging disc symptoms, the location of the bulging disc, and any previously attempted treatments.
Often a bulging disc will improve over time, so initial treatment usually focuses on pain management and monitoring the progress of the condition. Variables such as nutritional habits, weight, and smoking can contribute to disc degeneration, so most treatment protocols will address these issues as well.
Exercise Treatments for Bulging Discs
Exercise can help manage the debilitating lower back pain caused by bulging discs. Stretching exercises can help relieve pain and strengthen the muscles to prevent further injury. A low-impact aerobic conditioning program that strengthens your back will also help with pain relief.
Exercises to treat a bulging disc are:
• Pelvic tilt
• Knee to chest stretch
• Shoulder blade stretch
• Lower back rotational stretch
• Back extension
• Walking, stationary biking, or water aerobics
Physical therapy includes a combination of therapeutic exercises, pain control techniques, massage therapy, spinal decompression therapy, and functional training that can ease the pain and inflammation caused by a bulging disc. After evaluating your condition, a physical therapist will perform some tests and develop a physical therapy plan for you.
Patients with bulging discs usually have physical therapy sessions two to three times a week for about six weeks.
Some patients have found relief from their bulging disc symptoms through alternative treatments such as chiropractic care, acupuncture, heat therapy, and massage.
A chiropractor can help determine the type of bulging disc you’re suffering from, plus help you pinpoint some of the underlying causes. After diagnosis, a chiropractor will perform targeted adjustments to help realign the spinal discs and prevent protrusion into the spinal canal. The exact type of adjustments performed depends on what the chiropractor finds during a physical exam.
The ancient practice of acupuncture may help relieve lower back pain. Based on your diagnosis, the acupuncturist will insert multiple needles that are left in place for approximately 20-40 minutes. It has been suggested that acupuncture triggers a release of endorphins into the blood stream that helps relieve pain.
When received regularly, massage therapy may offer relief from chronic lower back pain. A massage involves the kneading, stroking, and manipulation of your back tissue. These movements increase blood flow, which delivers more oxygen and nutrients to the muscles. Extra blood also carries away waste byproducts that may accumulate over time.
Try ice and heat. Place an ice pack on your back for up to 20 minutes, several times a day. After exercise, after you come home from work, and when you go to bed are good times to ice your back. This will reduce swelling and inflammation and relieve pain. If your muscles aren’t having spasms, you can try a heating pad or warm compress.
Different pain medications work differently in the body and are used to treat different types of pain. Your physician will assess your pain, whether acute or chronic, and may suggest the following medication for pain relief.
• Acetaminophen (Tylenol): dampens how the brain perceives pain but does not reduce inflammation in the body.
• NSAIDs (non-steroidal anti-inflammatory drugs): available over-the-counter or by prescription, NSAIDs reduce inflammation in the body. Ibuprofen, Naxopren, and COX-2 inhibitors commonly used to treat chronic pain from bulging discs.
• Oral steroids: these powerful anti-inflammatory prescription medications are usually limited to short-term use during episodes of acute pain.
• Muscle relaxants: these drugs have a sedative effect on the entire body. They are often prescribed early in the treatment protocol for bulging disc treatment to alleviate the pain cause by muscle spasms.
• Narcotic pain medications: opioid pain relievers that contain codeine, propoxyphene, hydrocodone, or oxycodone reduce pain. However, since they are highly addictive, opioid pain relievers are generally prescribed for short periods of time to relieve acute lower back pain.
Pain Management Techniques
Pain management techniques are often used on chronic pain, such as the pain caused by bulging discs. Most patients find that they have to try several treatments or combinations of treatments to find what works best for them. Pain management techniques can help in combination with other treatments or on their own.
Patients suffering from lower back pain often have trouble sleeping. They have trouble finding a comfortable position, and lack of sleep can make chronic pain feel worse. If you tend to sleep on your back, place a pillow or rolled towel under the small of your back or a pillow under your knees. This helps keep the natural curvature of your spine. This is considered the best position for relieving lower back pain.
If you prefer to sleep on your side, put a pillow between your knees for additional support. Sleeping on your stomach is not recommended, as this position is the hardest on your back. However, if you must, place a pillow under your lower abdomen and pelvis to relieve the strain this position puts on your back.
Correct posture is a simple yet very effective way to keep your spinal cord healthy. When you have poor posture, you are putting strain on your spinal musculature. Over time, poor posture may change the anatomy of your spinal column. To ensure that your posture is giving your back the support it needs, avoid slouching forward when sitting, keep your weight on the ball of your feet when standing, and keep your head up when walking.
Inflammation is a natural part of your body’s defense against disease. However, chronic inflammation can lead to chronic lower back pain. An anti-inflammatory diet can help reduce the levels of pain in your body. Anti-inflammatory foods such as fruits and green leafy vegetables are high in natural anti-oxidants that protect the body from the damage caused by free radicals.
Epidural Steroid Injections
Lumbar epidural steroid injections (LESI) place corticosteroids directly into the epidural area of the spine in order to reduce inflammation and relieve pain. They usually consist of cortisone, an anti-inflammatory, and local anesthetics to offer short-term pain relief for degenerative disc disease.
Self-care such as lifestyle changes can help alleviate and manage low back pain and sciatica symptoms. These changes include:
• Staying active: keep the spine strong a flexible with stretching and low-impact aerobic exercise.
• Qutting smoking: cell damage caused by nicotine can increase sensitivity to pain, so quit or reduce smoking.
• Losing weight: excess weight puts stress on the spine and other joints.
• Standing up straight: keeping your spine aligned with correct posture will help keep your back pain-free.
Once a patient has exhausted non-surgical treatment options, their physician may recommend a surgical intervention to provide pain relief. While traditional open spine surgery can require several days of hospitalization, The Bonati Spine Procedures carry fewer risks, with no hospital stay necessary for a rapid recovery and proven results. The Bonati Spine Institute offers an array of procedures to treat a bulging disc, which may include:
A procedure in which the diseased portion of the disc that is causing nerve compression is removed using specially adapted patented endoscopic instruments, and the Holmium YAG laser may be used to shrink and remodel the remaining disc.
A foraminotomy is a decompression surgery performed in order to increase the space of the foramen and hollow out the passageway where the nerve roots exit the spinal canal. The procedure involves the removal of bone or tissue that obstructs the neuroforamen and compresses the nerve roots leading to inflammation and radiating pain. The removal of part of the lamina is often necessary for the surgeon to gain access to the affected nerve roots in the neuroforamen. For this reason, the foraminotomy is often performed in conjunction with a laminectomy or laminotomy.
A laminectomy/laminotomy is a surgical procedure performed to treat a bulging disc. The surgery is designed to relieve pressure on (decompress) the spinal cord or spinal nerve roots through the widening of the spinal canal. The procedure is carried out by removing or trimming part of the lamina (roof) of the vertebrae in the compressed area. The removal of part of the lamina creates an opening for the compressed nerves, relieving pressure on the nerve roots and reducing inflammation. The partial removal of the lamina may also allow the surgeon to remove any bone spurs or damaged tissue causing pain and inflammation in the patient. Laminectomy and laminotomy are often utilized in order to give the surgeon the proper space to perform the foraminotomy.
If you have already been diagnosed with a bulging disc, or continue to experience sciatica regardless of conservative treatments, or if you have undergone an unsuccessful failed back surgery, Dr. Bonati and the experienced staff of The Bonati Spine Institute can help.
The Bonati Spine Procedures are the most effective alternative to eliminate your pain. While traditional open spine surgery can require several days of hospitalization, The Bonati Spine Procedures require no hospital stay and have a rapid recovery.
Dr. Bonati is an innovator in the field of advanced spine surgery. He was one of the first endoscopic spinal surgeons in the U.S., and was the first to receive FDA approval for the use of a laser in spine surgery.