Bulging Disc Diagnosis & Treatments
What Are The Diagnostic and Treatment Options For A Bulging Disc?
Often patients who suffer from a bulging disc, do well with conservative therapy and never need to pursue interventional or surgical procedures. In fact, some patients with bulging disc often have their symptoms diminish within 4- 6 months. When symptoms are severe and last more than 3 months with no relief of conservative treatment, patients may benefit from further diagnostic injections, and least invasive or surgical procedures.
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.
• Pain Mapping Injections – These injections can be used for therapeutic relief but more important, can pinpoint the pain generator.
- Medications-Ant-inflammatories: muscle relaxers and on rare occasions narcotic medications
- Alternating Heat/Cold Therapy: during the first 24-48 hours
- Physical Therapy Exercises: including stretching, massage, and strengthening
- Chiropractic Care. Many patients find relief in seeing a chiropractor for re-aligning and improving motion in “locked” joints.
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 spinal level at which the pain originates from.
Least Invasive Procedures
If pain still persists after conservative treatment and interventional spine injectioms, 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 1/2 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 1-2 weeks. 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 1-2 weeks. 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 week 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.