In general, back surgery for a bulging disc is not required as they are often asymptomatic and present no immediate danger of spinal nerve damage. A bulging disc is not a herniated disc and is much more likely to heal of its own accord and retreat back into the correct disc space between the vertebrae. A herniated disc is a non-contained disc disorder, whereas a bulging disc is considered to be contained. This is because the annulus fibrosus (the outer shell of the disc) has not ruptured and is, therefore, still adequately containing the jelly-like nucleus pulposus in the disc itself.
Symptoms of a Bulging Disc
A bulging disc may be responsible for a pinched nerve and cause symptoms associated with a herniated disc such as neck pain or back pain, radiculopathy, paraesthesia in the upper or lower limbs, numbness, weakness, shooting pain upon certain movements, and altered sensation. In some cases a bulging disc may lead to a disc herniation which is more likely to cause these symptoms and apply more intense pressure to the spinal nerves. In this instance, back surgery may be considered appropriate but it is rarely performed to treat a bulging disc. There are many reasons surgeons advise against back surgery for a disc bulge, including the generally asymptomatic nature of the condition, the risks associated with any surgery, such as infection, anaesthesia issues, and scarring, and the simple fact that back surgery can in some cases actually worsen a condition that the patient could cope with using conservative treatments.
Bulging Disc Treatment
Patients with a bulging disc, or discs, are advised to follow a conservative treatment plan to minimize the risks of disc herniation, encourage the disc bulge to retract and repair itself, and relieve any symptoms they might be experiencing due to the impingement of the disc material on the spinal nerves. Therapies may include the use of NSAIDs and analgesic medications, chiropractic treatment, or osteopathy, massage, gentle stretching and strengthening exercises through physical therapy, and non-surgical traction.
Patients will usually be given specific advice on avoiding certain movements, such as twisting, heavy lifting, and high-impact exercise or contact sports to reduce the risks of jolting the spine and causing the disc to herniate. For all patients with a bulging disc, staying hydrated can make a significant difference to the chances of disc herniation and complication. The more dehydrated a patient becomes the more brittle and dry the intervertebral discs are and this makes them much weaker and liable to rupture. Specific exercises for a bulging or herniated disc in the neck or back can also help.
Non-Surgical Traction for a Bulging Disc
Non-surgical traction therapy is usually the preferred course of action for patients with a bulging disc, as this treatment does not carry the risks associated with back surgery, can successfully resolve symptoms and remove the need for surgery. Many chiropractors offer non-surgical traction using expensive and elaborate machines at their clinics. Sessions usually last about half an hour and patients may need a number of such sessions to achieve decompression. These machines work by using a cycling rhythm of gentle distraction to decompress the spine. The patient lies on the computerized table and the machine is programmed to apply a certain amount of force at a specific angle in order to gently extend and relax the spine to reduce intradiscal pressure, and create a vacuum-like effect.
Non-surgical traction therapy encourages the decompression of the back, thus allowing the disc bulge to retract into the vacuum created by the cycle. The machine’s gentle cycling effect can help reduce the body’s natural inclination to resist the movement and cause muscle spasms. Evidence of the effectiveness of non-surgical traction is currently rather poor, with most ‘success stories’ published by individuals and organizations set to profit through promotion of the therapy. The expense of non-surgical traction, and the amount of time the treatment can take is discouraging to some patients. Additionally, the treatment may be considered dangerous if it prevents a patient from receiving a proper diagnosis and treatment by qualified health professionals in a timely manner as this can increase the risk that a bulging disc herniates or causes permanent nerve damage.
There are other traction devices that patients can use at home, although the use of these non-surgical traction devices should be discussed with the patient’s physical therapy prior to use as they could exacerbate the condition if used incorrectly. Examples of back-pain relief devices include those that provide gentle traction and encourage the patient’s spine to relax and achieve the correct alignment. Many patients also find inversion tables effective for encouraging a bulging disc to heal as these allow the spine to relax and realign itself as the usual stresses and strains are removed when the spine is inverted.
Back Surgery for a Bulging Disc
If the disc does herniate then several back surgeries can be considered, with the minimally invasive spine procedures usually offering the better option for patients in terms of recovery and reduced complications. Discectomy or partial discectomy can be conducted endoscopically, with laser surgery in some cases, and excises the material which is causing a trapped nerve. This may be done along with a laminotomy, laminoplasty, or laminectomy, depending on the amount of material to be removed, the number of intervertebral discs involved in the degeneration, and the presence of confounding factors such as osteophyte growth or joint hypertrophy. In the more invasive procedures, such as laminectomy, the patient may also require spinal fusion to maintain the stability of the spine.
In some cases the patient may have an artificial disc replacement or the TLIF procedure to fuse the vertebrae together and maintain intervertebral height after the removal of the disc. The X-Stop is not indicated in cases where a disc has herniated but may be considered appropriate by some surgeons for patients with a single instance of a bulging disc. The X-Stop device can help prevent patients from compressing the spine further and reduce the risk of a herniation occurring. The restoration or correct intervertebral height can also encourage a bulging disc back into the correct disc space and reduce any nerve compression.
If back surgery for a bulging disc or one that has herniated is indicated then patients should ensure that they are in good physical health generally, of an optimum weight, have quit smoking, and have informed their physician of all medications being used (whether prescribed or non-prescribed) to increase the chances of surgery being successful. Eating a healthy, balanced diet is also beneficial to promote recovery and it is also extremely important to drink sufficient water in order to keep the intervertebral discs hydrated both before and after surgery.