Disc Bulges And Disc Herniations
Disc bulges and disc herniations are common spinal conditions where the soft, gel-like center of an intervertebral disc protrudes beyond its normal boundaries. While a bulge involves the disc extending outward symmetrically, a herniation occurs when the disc’s outer layer tears and the inner material leaks out. These conditions can compress nearby nerves, causing pain, numbness, and weakness. They most commonly affect the lower back and neck and can result from age-related degeneration, injury, or repetitive strain.
What is it?
Intervertebral discs are cushion-like structures between the bones (vertebrae) of the spine that act as shock absorbers and allow flexibility. Each disc consists of a tough outer ring called the annulus fibrosus and a soft, jelly-like center called the nucleus pulposus. A disc bulge occurs when the entire disc extends beyond its normal space, typically due to wear and tear that causes the outer ring to weaken and stretch. A disc herniation, also called a ruptured or slipped disc, is more severe—it happens when the outer ring tears or ruptures, allowing the inner gel-like material to leak out into the spinal canal.
Both conditions are most common in the lumbar spine (lower back), particularly at the L4-L5 and L5-S1 levels, and in the cervical spine (neck) at C5-C6 and C6-C7. Risk factors include aging, as discs naturally lose water content and become less flexible over time, repetitive lifting or twisting movements, obesity, smoking, and genetics. While many disc bulges and small herniations cause no symptoms and are discovered incidentally on imaging, larger herniations can compress spinal nerves or the spinal cord itself, leading to significant pain and neurological symptoms.
Important to Know
The symptoms of disc bulges and herniations depend on their location and whether they compress neural structures. In the lumbar spine, compression can cause sciatica—sharp, shooting pain that radiates down the leg, often accompanied by numbness, tingling, or weakness in the leg or foot. In the cervical spine, herniated discs can cause neck pain, shoulder pain, and symptoms radiating down the arm. Most cases improve with conservative treatment including rest, physical therapy, anti-inflammatory medications, and sometimes epidural steroid injections. Surgery is reserved for severe cases with progressive weakness, loss of bowel or bladder control, or pain that doesn’t respond to conservative measures. MRI is the gold standard for diagnosing and characterizing disc problems, as it provides detailed images of both the disc and surrounding neural structures.