Bulging Disc Diagnosis and Treatments
What Are The Diagnostic and Treatment Options For A Bulging Disc?
In most cases of a bulging disc, intervention and surgery are not necessary. Many patients with bulging disc often have their symptoms diminish within 4- 6 months. Nonsurgical treatment initially works to relieve symptoms.
How is a Bulging Disc Diagnosed?
A comprehensive diagnostic workup is essential to properly diagnose a bulging disc. The following workup provides an accurate and thorough diagnosis and treatment option.
- Medical History – Inventory of symptoms, previous treatments and medical care.
- Physical Examination – A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic Tests – Generally, plain x-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.
- Diagnostic Pain Injections and Mapping – Pain injections are used to provide therapeutic and pain relief, as well as pinpoint and confirm the pain generator in the spine.
- Medications: Anti-inflammatories, muscle relaxers and on rare occasions narcotic medications
- Alternating Heat/cold Therapy during the first 24-48 hours
- Physical Therapy: including stretching, massage, and strengthening
Interventional Spine Procedures
- Epidural Steroid Injections: are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.
- Percutaneous Discectomy: under fluoroscopic X-ray guidance a physician can guide a device that can be inserted into the bulging disc to decompress the disc and take the pressure off of the nerve.
Least Invasive Procedures
If pain still persists and patient is intolerant to the pain after non-surgical treatment and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended.
The following least invasive procedures can treat bulging disc with 90% success:
- Endoscopic Discectomy: With an incision less than a ¼ inch. The surgeon can avoid all lamina bone resection and enter the spinal canal without disturbing or cutting muscle. The surgeon directly observes the herniated disc in a water (arthroscopy) environment with a surgical working channel endoscope coupled with a HD camera. Recovery is superior to microdiscectomy with most patients returning to work within a week. Conscious sedation is used with the patient awake, comfortable and aware during the procedure.
Most patients can begin getting out of bed one hour after surgery and go home shortly afterwards. Activity is gradually increased and patients are typically able to return to work within a few days. There will probably be some pain after the procedure and is usually localized to the incision site. However, just because there is less or no pain, always consult your physician or orthopedic surgeon before beginning any physical work.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.