Dr. Kaixuan Liu explains the differences and similarities between Herniated and Bulging Discs.
There's a lot of confusing lingo out there surrounding spinal disc problems, with many people wondering if herniated and bulging discs are the same thing. But it's crucial to understand both the differences and similarities between these two highly common back conditions in order to seek proper treatment, according to Kaixuan Liu, MD, founder of Atlantic Spine Center.
The bottom line is that bulging discs and herniated discs (also called ruptured discs) are two different problems. But they can cause similar symptoms, though treatment for each can vary widely depending on its severity, Dr. Liu says. Understanding the anatomy of the spine is key to differentiating the two.
"The spine's vertebrae are separated by spongy, oval-shaped discs that serve to cushion the spinal column and maintain spaces between the bones," explains Dr. Liu, who is fellowship-trained in minimally invasive spine surgery.
What is bulging disc?
"A bulging disc means that disc annulus is squeezed out of vertebral body surface, though the disc's outer layer is intact and no center gel like sponge leak out the disc”.
A bulging disc refers to the condition when the inner nucleus of a vertebral disc protrudes to its outer layer. A disc bulge may happen as a result of a great amount of pressure being placed on the disc, or if the disc has degenerated from age and other factors. Just because a bulge has occurred doesn't mean there will be any bulging disc symptoms; it is only when it comes in contact with surrounding tissues or nerves that it begins causing problems.
Bulging disc causes
The weakening of a disc from degeneration as we age is the main cause of a bulging disc. As we age, daily wear and tear weaken structures and other components of the spine.
This natural degenerative process weakens the disc, making it harder and harder to handle the pressure placed on it when performing normal daily activities. This usually results in a bulging disc in the lower and upper back, which may press on the nerves near it causing pain and other symptoms.
What is a herniated disc?
Conversely, a herniated disc's outer layer has broken, allowing the spongy center to leak out of disc and commonly into the spinal canal.
Herniated disc causes
A herniated disc has a broken outer layer that allows some of the gel-like center to leak into the spinal canal.
Herniated disc causes include natural reasons such as gradual wear and tear. So, it can be called a result of aging processes.
Diagnosis
Diagnosis relies on symptoms and imaging tests. Given some basic differences between the two conditions, you'd think each triggered a different set of symptoms. But that's a misconception, Dr. Liu says. In reality, both bulging and herniated discs can irritate or press on nerve roots spreading from the spine to other body areas – causing pain and other potentially debilitating symptoms such as tingling, numbness and muscle weakness. Although a bulging disc is often noted as a normal disc, it is frequently associated with disc degeneration (aging) and produces similar symptoms as a herniated disc.
About one-third of bulging or herniated discs don't cause any symptoms, but herniated discs are more likely, because of their more severe nature, to trigger pain than bulging discs, he says. Herniated or bulging discs in the neck will produce symptoms in the neck, shoulder and arms, while herniated or bulging discs in the back will lead to symptoms in the lower back, buttocks, legs or feet.
Discerning whether a patient's symptoms are caused by a bulging vs. a herniated disc depends on two factors: a thorough physical exam and imaging tests, such as x-ray or MRI scans, that can pinpoint exactly how damaged a spinal disc has become.
Treatment options for bulging or herniated discs:
Fortunately, treatment options for either problem are extensive, Dr. Liu notes. But treatment approach depends on several factors, including severity and length of symptoms; the patient's age; and if extreme symptoms are present, such as intense numbness or weakness.
Conservative, non-surgical measures are appropriate and effective for most patients, he says. They include:
- Rest
- Prescription and over-the-counter medications, including NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants or narcotics
- Physical therapy
- Steroids injected into the spinal area or taken orally, which control pain and reduce swelling
- Heat or ice
- Ultrasound therapy
- Electrical stimulation therapy
If surgery is necessary – which typically only occurs for herniated, not bulging, discs – that decision is made between doctor and patient only after conservative treatments haven't produced any relief after 6 to 12 weeks.
"Surgery can include both minimally invasive or ‘open' approaches, but it's only considered as a last resort or if extreme and dangerous neurological symptoms are present," Dr. Liu says. "The good news is we can provide substantial relief to the vast majority of patients with conservative measures, and they can quickly return to their favorite activities feeling much better."
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