Generality
Discal bulging is a discopathy, characterized by the crushing and the subsequent slippage, with respect to its canonical position, of an intervertebral disc.
Discal bulging recognizes in the consequences of aging its main cause; however, it can also depend on other conditions or circumstances, such as trauma to the spine or the repeated lifting of heavy objects in an unhealthy way for the back.
Discal bulging is symptomatic only when the intervertebral disc involved in crushing comes into contact with the nearest spinal nerves. In these circumstances, in fact, we are witnessing a phenomenon of nervous compression.
A diagnosis of accurate disc bulging that clarifies the causes is essential for the most appropriate treatment planning, which can be conservative or surgical depending on the severity of the condition.
Short revision of the spine
Carrier axis of the body, the spine or spine is a bone structure of about 70 centimeters (in the adult human being), which includes 33-34 irregular bones ; stacked on each other and joined together by means of so - called intervertebral discs, these irregular bones are the known vertebrae .
VERTEBRAE
In a generic vertebra three characteristic elements can be recognized, which are:
- The vertebral body, in anterior position;
- The vertebral arch, in posterior position;
- The vertebral hole . It is the opening resulting from the particular arrangement of the vertebral arch with respect to the vertebral body.
The set of vertebral holes of all the vertebrae constitutes the so-called spinal canal ; in the spinal canal houses the spinal cord .
INTERVERTEBRAL DISCS
An intervertebral disc is a circular fibrocartilaginous structure, which contains within it a gelatinous substance, called the pulpy nucleus, and the cartilaginous tissue that surrounds the aforementioned nucleus pulposus, ie the so-called fibrous ring .
In addition to providing for the conjunction of the adjacent vertebrae, the intervertebral discs have the task of absorbing, by means of the pulpy nucleus, the shocks and loads that weigh on the spine.
What is Bulging Discale?
Discal bulging, or disc protrusion, is a degenerative condition of the vertebral column, characterized by a deformation of an intervertebral disc, such that the latter is crushed and out of axis with respect to the other intervertebral discs.
Using a comparison to simplify the concept just described, what happens in discal bulging is equivalent to the effect that the crushing of a sandwich filled with a spreadable cheese has: the latter, when crushing occurs, comes out in one or more sides of the two slices of bread.
Discal bulging is an example of discopathy (ie a disease of the intervertebral disc ) and represents, in a fair number of cases, the prelude to a herniated disc (or herniated disc ); in medicine, the term "herniated disc" indicates the exit from its natural seat of the nucleus pulposus, contained within the intervertebral disc.
Did you know that ...
The difference between discal bulging and herniated disc is that, in the first situation, the fibrocartilaginous structure of the intervertebral disc is intact, while, in the second situation, it is damaged (for this there is an exit of the nucleus pulposus).
In which section of the spine can bulging discal be located?
The phenomenon of disc bulging can affect, in order from the most affected to the least affected, the lumbar tract, the cervical tract and the thoracic tract of the spine.
Discal bulging with an intervertebral disc characterizing the cervical spine is called cervical disc bulging ; disc bulging with a leading thoracic intervertebral disc is called thoracic discal bulging ; Finally, bulging discal damage to a lumbar intervertebral disc is more properly known as lumbar discal bulging .
Causes
The intervertebral discs of a young adult or middle-aged individual are 90% water; this water ensures their elasticity, resistance to deformation and cushioning capacity.
With advancing age and the consequent aging of the human body, however, the intervertebral discs are subject to progressive degeneration, which induces the irreversible loss of a large part of the aforementioned aqueous component.
The loss of water by the intervertebral discs makes them more fragile, less elastic, prone to deformation and prone to breakage.
This premise is important, because the phenomenon of discal bulging is mainly related to the changes that the aging of the human body causes to damage the intervertebral discs; in other words, disc bulging recognizes the degeneration of intervertebral discs due to aging.
Did you know that ...
The degeneration of intervertebral discs due to aging is a medical condition, which is called degenerative discopathy .
Other causes of disc bulging
After aging, the other causes / risk factors of discrete bulging worth mentioning are:
- Trauma to the spine .
Spinal injuries following violent falls, falls from great heights, road accidents and sports injuries are closely related to the phenomenon of discal bulging.
- The repeated lifting is achieved with the wrong modes of very heavy objects .
The worst way to lift a heavy object is to lean forward and rely on the use of arms and back; the correct way, on the other hand, is to keep your back straight and use only the bending of your legs.
- Excessive weakening of the muscles and / or ligaments of the back .
The muscles and ligaments of the back support the spine and guarantee its normal anatomy; if they are weak, the spine lacks a fundamental support and develops deformities, which can also affect the intervertebral discs.
- Genetic predisposition to deformation of intervertebral discs .
Some genetic conditions coincide with an alteration of the internal composition of the intervertebral discs; this alteration represents a factor favoring the phenomena of disc deformation, such as discal bulging.
- Wrong habits and behaviors that affect the health of the spine .
According to various researches, the tendency to take wrong postures, obesity, a sedentary lifestyle, excessive physical activity and a poor diet are all circumstances that, especially if combined together, weaken the intervertebral discs and favor the deformation phenomena to them load.
Symptoms and Complications
Spinal nerves originate from the spinal cord present in the spinal canal of the spine.
In normal conditions, these nerves, passing out of the spinal cord, pass in the immediate vicinity of the intervertebral discs, without however coming into contact with them.
The extreme closeness between the intervertebral discs and the spinal nerves, however, means that, when the former undergo a certain deformation, they exert a compression on the latter, giving rise to that set of characteristic symptoms known in the medical field as nervous compression syndrome .
In such a scenario, the bulging discal dresses the clothes of deformation capable of causing a nervous compression syndrome, when it is such as to come into contact with the nearest spinal nerves.
Typical events
Discal bulging is responsible for symptoms such as pain, numbness, stiffness, tingling and muscle weakness along the entire path of the nerve or spinal nerves that it compresses. This means that a cervical disc bulging will induce symptoms other than a thoracic or lumbar discal bulging.
The symptoms of disc bulging vary depending on the location of the disc deformation.
Cervical discal bulging: the symptoms
When disc bulging is at the cervical level, the symptom picture can include:
- Neck pain ( cervicalgia );
- Pain in the shoulders, arms and / or hands;
- Headache;
- Sense of numbness in the face, arms and / or hands;
- Weakness in the muscles of the shoulders, elbows, wrists and / or hands.
Chest discal bulging: the symptoms
When placed at the thoracic level, disc bulging usually causes pain that, on the back, tends to radiate to the front of the chest and to the stomach.
Did you know that ...
Thoracic discal bulging causes symptoms that are very similar to those caused by a heart problem.
Lumbar discal bulging: the symptoms
When localizing along the lumbar spine, disc bulging can cause symptoms such as:
- Chronic pain in the lumbar area of the back ( low back pain );
- Pain in the buttocks, groin, thighs and / or legs;
- Sense of numbness in the lower limbs;
- Tingling in the lower limbs;
- Weakness in the muscles of the thigh, calf and / or feet.
Curiosity
When a lumbar discal bulging causes pain, tingling, muscle weakness, etc. on the buttock, posterior to the thigh, knee and legs, and on the foot, most probably the deformation present induced the compression of the sciatic nerve .
In the medical field, compression of the sciatic nerve is known in many different ways, including: sciatica, sciatica and inflammation of the sciatic nerve .
Asymptomatic discal bulging: what are the reasons
Discal bulging can also be an asymptomatic condition.
This occurs when the deformation of the intervertebral disc, the protagonist of the condition, does not come into contact with the nearest spinal nerves.
According to some statistical studies, the number of cases of disc bulging is not negligible.
The absence of symptoms from a bulging disc does not mean that the latter will never cause any disturbance in the future; a possible worsening of the disc deformation, in fact, could represent the trigger for the appearance of pain, tingling etc.
Complications
If severe or if the cause that triggers it does not receive the right therapeutic care, a bulging disc may lead to a herniated disc.
A herniated disc causes the same symptoms as discal bulging, but more severe and debilitating; furthermore, in the most advanced cases, it could give rise to serious problems such as: lack of sensitivity in the upper limbs, lameness, lack of sensitivity to the lower limbs, loss of control of the bladder or anal sphincter, severe muscle weakness at the level of arms etc.
When should I go to the doctor?
Symptoms such as those found in the presence of disc bulging deserve immediate medical evaluation, when:
- Despite the rest, the symptoms worsen rather than improve;
- There was a sudden and unreasonable worsening of the symptoms;
- The symptoms follow a violent trauma to the neck or back;
- In addition to the classic symptoms (eg pain), the patient also complains: loss of control of the anal sphincter or visceral sphincter, complete lack of sensitivity, etc.
Diagnosis
As a rule, for the diagnosis of bulging discal and the identification of its triggering causes, the following are fundamental:
- A thorough physical examination and a careful medical history . They are used by the doctor to understand what the symptoms are, why and when the condition has arisen, how serious the condition is, etc.
- A neurological evaluation . Helps to shed light on: the health of spinal nerves, the site of nerve compression, the severity of deformation, etc.
- Radiological images provided by tests such as nuclear magnetic resonance (NMR) of the spine or CT (computerized axial tomography) of the spine.
- Electromyography . It consists in the study of the conduction of nerve signals along the anatomical area manifesting the symptoms and in the control of the activity of the muscles present in the same area.
A scrupulous diagnosis, which also brings to light the causes of deformation, is fundamental to the planning of the most appropriate treatment.
Therapy
Distal bulging deserves all the appropriate care when it is symptomatic. The treatments in question, however, are not the same under all circumstances, but vary according to the severity of the condition; in fact, for the less severe cases of disc bulging, a conservative treatment (conservative therapy ) is sufficient, whereas, for cases of more severe disc protrusion and for those resulting in complications, the use of a surgical treatment is indispensable ( surgical therapy ).
Conservative therapy
Conservative therapy of disc bulging is based on a period of rest and, depending on the causes, on remedies, such as:
- Physiotherapy and postural education . In a context of disc protrusion, their aims are: to correct posture errors, to strengthen the back muscles and, finally, to increase the flexibility of the trunk and spine;
- Drugs . Potentially useful medicines include: anti-inflammatory drugs such as NSAIDs, muscle relaxants, tricyclic antidepressants (*), anticonvulsants (*) and corticosteroids (**);
- Massage therapy . It is a practice recommended to reduce pain.
- Control / abolition of behaviors favoring deformation of intervertebral discs . For example, a patient suffering from obesity must follow a weight loss treatment, while an excessively sedentary patient must practice regular physical activity.
Statistics show that, if the patient is careful in following it, a good conservative treatment for disc bulging has clear benefits, from the point of view of symptoms, after about 6 weeks from the beginning of treatment.
* NB: although their indication of specific use is another, tricyclic antidepressants and anticonvulsants have shown a certain efficacy even on the pain deriving from the compression of the peripheral nerves.
** NB: the use of corticosteroids occurs only when the NSAIDs are ineffective.
Surgical therapy
Surgical treatment of disc bulging consists of a discectomy .
Discectomy is the surgical procedure that involves the removal of a damaged or no longer functional intervertebral disc, and the replacement of the latter with a sort of prosthesis.
From the operational point of view, discectomy is a complex procedure, because it requires the incision of an extremely delicate area of the body, given the dense network of nerves, ligaments and blood vessels present.
The complexity of discectomy is the reason why doctors only practice it in severe cases or when conservative remedies are completely ineffective.
Prognosis
For those suffering from disc bulging, the prognosis depends on:
- The severity of the deformation of the intervertebral disc triggering the symptomatology.
When the deformation is slight, the chances of complete healing are greater than when the deformation is severe.
- Correction of favoring factors. Controlling / abolishing wrong behaviors associated with distal bulging protects against deterioration and complications.
Prevention
At the moment, there is no remedy that can prevent a condition such as disc bulging with a 100% probability. However, by resorting to certain precautionary measures, the risk can be drastically reduced; that's how:
- Use your body properly when lifting weights;
- Maintain a correct posture, especially in a sitting position, so as not to alter the normal anatomy of the spine;
- Exercise regularly, because inactivity is an important and established factor predisposing the disc bulging.
