The disc is the shock absorber in between the vertebrae of your spine. It allows your spine to twist, bend, flex and extend. A herniated disc occurs when the outer rim of the disc (annulus) weakens allowing the inner portion of the disc (nucleus pulposus) to push out. This can occur from a weakened annulus in younger patients from the disc being under too much stress or load from sudden twisting or bending. It may occur in slightly older patients from generalized wear and tear and gradual weakening of the annulus. The rupture in the disc will often cause extreme back pain. When the piece of disc protrudes or extrudes beyond the outer rim of the disc it can apply direct pressure on the spinal nerves. When the disc hits the nerves it can cause excruciating arm or leg symptoms depending on if the herniated disc occurred in the neck or back. Often patients will describe a sudden onset of pain as opposed to a gradual onset of symptoms over months or years that is more typically in degenerative disc problems.
These two terms are often used interchangeably. However, the term herniated disc is typically used when there is a more focal localized piece of disc material that moves back into the spinal canal or into a nerve root. Typically the term herniated disc is used when this occurs in a moments notice. It can happen with a sudden twist, bend, sneeze, or you could simply just wake up with the pain one day. In this case patients will often feel a sudden onset of acute, sharp, shooting pain that can be extremely debilitating. Bulging discs often refer to discs that have more generalized protrusions that typically occur slowly over time. In this case, patients usually do not report a sudden onset of pain, rather the onset of symptoms is much more gradual. Bulging or incompetent discs often lead to more back pain as opposed to leg symptoms, or you could experience both. If the bulging disc is in your neck you may experience no symptoms at all, or you may have neck or arm pain.
Symptoms from herniated discs can often resolve on their own with a rest and anti-inflammatories, pain medication or muscle relaxants. Physical therapy, massage, heat, ice, or epidural steroid injections with very small amounts of local anesthetic or steroids can also treat the symptoms of a herniated disc. When these treatments fail, a small 3 to 15 mm incision can be made and a minimally invasive microdiscectomy can be performed to remove only the small portion of the disc that herniated. This procedure leaves 90% of the disc intact. It only removes the piece of disc that is applying pressure to the nerve which is causing symptoms. The procedure has minimal blood lose, is outpatient, and has a suture-less tiny incision.