Most people experience back pain at some point in their lives. It’s no wonder – the spine is a complex structure used in almost every activity in daily life. It supports the head, shoulders, and upper body, as well as allows us to stand, bend, and twist. There are a wide range of terms used to describe spinal conditions associated with back pain. Slipped disc, pinched nerve, bulging disc, and ruptured disc are used interchangeably, which can cause a lot of confusion, but all of them can irritate the nerve and cause back pain. Although these spine conditions can be very painful, many people recover after a few weeks or months of nonsurgical treatment.
The spine is comprised of small bones called vertebrae. These are stacked on top of each other and form the natural curves in your spine. The vertebrae provide a protective layer for the spinal cord and nerves. Between each set of vertebrae, there are small, round discs that act as a cushion between the vertebrae. Each disc has a jelly-like center (nucleus) that is surrounded by a tough outer ring (annulus).
When a disc herniates, the nucleus pushes against the outer ring (annulus) and puts pressure on the sensitive spinal nerves, causing back pain, numbness, tingling, and/or weakness. If this occurs in the low back (lumbar spine), it can put pressure on the nerve root leading to pain in the buttocks, legs, and feet. This is called sciatica. Although less common, herniated discs can also occur in the upper spine (thoracic spine) or neck (cervical spine). When they occur in the neck, it can cause symptoms in the shoulders, arms, and hands.
Herniated discs, also known as slipped discs or ruptured discs, are a very common spine injury. Sudden injuries usually occur with lifting, pulling, bending, or twisting movements. They can also occur from age-related weakening of the spinal discs. As people age, the discs gradually deteriorate. There is less water content so they shrink and the spaces between the vertebrae get narrower, which increases the likelihood of a herniated disc.
The main difference between a herniated disc and a bulging disc is that the nucleus does not push out of the annulus in a bulging disc. The disc simply bulges out of the space it normally occupies in the spine. Considered a normal part of aging, a bulging disc may not even cause any symptoms. If it bulges enough to press on spinal nerves or narrow the spinal canal, then it can lead to symptoms including pain, numbness, tingling, or weakness. A bulging disc can sometimes be a precursor to a herniated disc.
To determine the cause of your back pain, your neurosurgeon will conduct a physical exam and order imaging tests, such as x-ray and MRI. Initially, these common disc conditions are typically treated with nonsurgical methods including pain-relieving medications, muscle relaxers, corticosteroid injections, or physical therapy. If conservative treatment methods do not work, your neurosurgeon may recommend lumbar microdiscectomy, one of the most common surgeries to alleviate back pain from herniated or bulging disks. It involves removing the herniated part of the disc and any fragments that are putting pressure on the spinal nerve. It’s an outpatient procedure, meaning you go home the same day, rather than staying in the hospital overnight. After surgery, patients will start physical therapy and learn exercises to strengthen their core. It’s a minimum three-month recovery before you can resume activities. With a herniated disc, you have a hole in the annulus and it will never be as strong as it was originally. You need to give it time to heal and don’t want to stress it too quickly.