With back pain causing more lost work productivity than any other medical condition in the United States, who hasn't heard the complaint, "Oh, my aching back?" But many people don't know the difference between bulging discs and herniated discs, two of the most prevalent spinal conditions triggering acute and chronic back pain, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center.
While bulging discs and herniated discs in the neck or back are similar – and can cause similar symptoms, or even no symptoms at all – treatment for each problem can vary widely depending on its severity, Dr. Kadimcherla says.
Understanding the Anatomy
To distinguish between the two, it's important to first understand the basic anatomy of the spine. The spinal bones are separated by spongy, oval-shaped discs that cushion the spinal column and create space between the vertebrae. When those discs move out of place (bulge) or break open (herniate) – whether from injury, strain or aging – the vital shock-absorbing protection they provide is jeopardized.
"The often-used analogy of spinal discs resembling miniature jelly doughnuts is pretty apt," explains Dr. Kadimcherla, who is fellowship-trained in orthopedic and neurosurgical spine surgery. "When a disc is bulging, its gel-like center protrudes into the spinal canal, although the outer layer of the disc is intact. A herniated disc, on the other hand, has a broken outer layer that allows some of the gel-like center to leak into the spinal canal."
Troublesome symptoms for both bulging and herniated discs
In everyday conversation, bulging and herniated discs are often referred to as "slipped" or "ruptured" discs, respectively. But no matter what they're called, both can irritate or press on the nerve roots extending from the spine to various parts of the body – with the resulting pain often compounded by other potentially disabling symptoms such as numbness, tingling and muscle weakness.
Either type of disc problem is a clear sign of problems in the surrounding areas of the spine, though herniated discs – because of their more compressive nature – are more likely to cause pain than bulging discs, Dr. Kadimcherla notes.
"The only difference between a herniated disc in the neck and a herniated disc in the back is that the first will give you pain and symptoms in the neck, shoulder and arms," he says, "while the other will present with symptoms in the lower back, buttocks, legs and feet."
Extensive treatment options
About 30% of bulging or herniated discs don't cause any symptoms and may be detected by accident during imaging scans for another health condition. But with the vast majority of disc disorders affecting patients' quality of life, Dr. Kadimcherla points to an arsenal of treatments that, depending on the severity of the condition, can quickly or gradually get patients back to their favorite activities.
- Prescription and over-the-counter drugs such as nonsteroidal anti-inflammatory medications (NSAIDs), muscle relaxants or narcotics
- Physical therapy that includes instruction on how to properly lift, dress, walk and perform other activities, how to strengthen muscles and how to increase flexibility in the spine and legs
- Chiropractic manipulation of the spine
- Steroids given by pill, injection or intravenously to control pain and reduce swelling around the disc
- Surgery, including minimally invasive and "open" approaches
Treatments are often combined to increase the odds of success, Dr. Kadimcherla says. And as with other types of back pain, surgery is considered a last resort, used for herniated discs in the lower back if certain conditions are present:
- Leg pain hasn't improved with at least six weeks of nonsurgical treatment and symptoms require strong pain medicine or interfere with normal activities
- Weakness, loss of motion or abnormal sensitivity is present
"Disc surgery isn't considered effective treatment for lower back pain that's not brought on by a herniated disc," Dr. Kadimcherla says. "But it's crucial that patients allow their physicians to carefully assess their case and determine the best ways to tackle pain and other ill effects of bulging or herniated discs. In most cases, we're able to provide substantial relief."