Bulging disc systoms

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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The disc is a complex structure that carries two principal functions: connects two vertebra together (while permitting some motion) and provides a shock absorbing function. The disc is located between two vertebra and looks like a very solid “doughnut” made of multiple outer fibrous layers (called the 'annulus' which means "ring") while containing a jelly-like substance in the middle (called the 'nucleus').

With age, the intervertebral disc may lose water and become dried out. As this happens, the disc compresses. This may lead to the deterioration of the tough outer ring allowing the nucleus, or the inside of the ring, to bulge out. This is called a bulging disc.

A ruptured disc means that an unusual and excessive load has been applied on a disc resulting in the rupture of all or most of the layers of the annulus. The consequence is a disruption of the binding ligament and leakage of the jelly (nucleus pulposus) out of the boundaries of the annulus. As a consequence the two vertebrae connected by the disc which suffered the injury are no longer smoothly bound together and a combination of instability and nerve irritation can lead to severe back pain.

When a disc bulges beyond its normal position nerve irritation may occur which is often call a "pinched nerve" or sciatica. Varying degrees of disc herniation may occur ranging from " bulge" (which is usually not serious) to "large herniation" or "extrusion".

It is often not clear what causes a disc to herniate. The application of unusual loads may compress the disc in such a way that part of the jelly (nucleus) gets out of the boundaries of the annulus and is partially or totally extruded backward, where the ligaments are weakest. The disc fragments may get stuck in the spinal canal. The canal can not expand and the presence of the disc fragment takes up the space of the nerves thus leading to compression of one or several nerve roots.

The symptoms of lumbar disc disease vary depending on where the disc has herniated, and what nerve root it is pushing on. The following are the most common symptoms of lumbar disc disease. However, each individual may experience different symptoms. Symptoms may include:

• intermittent or continuous back pain (this may be made worse by movement, coughing, sneezing, or standing for long periods of time)
• spasm of the back muscles
• sciatica - pain that starts near the back or buttock and travels down the leg to the calf or into the foot.
• muscle weakness in the legs
• numbness in the leg or foot
• decreased reflexes at the knee or ankle
• changes in bladder or bowel function


Pain follows a nerve root distribution and can go to the hip, the knee, the calf or the ankle and the foot. If there are no severe neurological symptoms (weakness, abnormal reflex…) conservative management is likely to be successful. Surgical treatment is only considered in rare cases of intractable excruciating pain, which does not improve, and/or severe neurological symptoms.

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