Sciatica bulging disc
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known 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 spine is arranged so that vertebrae "stacked" on top of each other can provide support while also protecting the spinal cord from injury.
Each vertebrae has a spinous process, which is a bony prominence behind the spinal cord that shields the spinal cord. The vertebrae also have a strong bony "body" in front of the spinal cord to provide for weight-bearing.
Spongy discs are pads that act as "cushions" between each vertebral body. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus). This softer component can rupture (herniate) through the surrounding outer ring (annulus fibrosus) and irritate adjacent nervous tissue. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured, pain can result.
Weakness of the outer ring leads to disc bulging and herniation. As a result, the central softer portion of the disc can rupture through the outer ring of the disc and compress the spinal cord or nerves as they exit the bony spinal column.
When nerves are irritated in the low back from degenerative disc disease, the condition is called lumbar radiculopathy and it often causes "sciatic" pain that shoots down the leg. This condition can be preceded by a localized low back aching. Sciatica pain can follow a "popping" sensation and be accompanied by numbness and tingling. The pain commonly increases with movement and can increase with coughing or sneezing. In more severe instances, lumbar radiculopathy can be accompanied by incontinence of the bladder and/or bowels.
Radiculopathy is suspected from the symptoms. Physical exam can also support the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect the nerve irritation. Disc herniation can be detected with CAT or MRI scanning.
The treatment of radiculopathy consists initially of nonsurgical (medical) management and progresses to surgery if there is no response.
Medical management of radiculopathy includes patient education, medications to relieve pain and muscles spasm, epidural injection, physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury).
With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine, and the age and health of the patient.
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