The discs in our backs have the critical function of enabling the movement of the spine without injury to the vertebral bones. However, if a disk bulges out of place, it could exert pressure on the surrounding nerves, causing pain throughout the back and the whole body. When this happens, you may have to undergo treatment, and one of the treatment options is surgery. For a successful surgery, you must see an experienced neuro-interventional surgeon.
At Dr. George Rappard's Practice, we frequently treat bulging disc symptoms for patients seeking these services in Los Angeles, CA. We thoroughly review patients' conditions before determining whether they must undergo surgery or if other treatment options suffice.
If the patient must undergo surgery, we use the most advanced techniques to achieve the best possible outcome while ensuring the patient feels comfortable and relaxed throughout the procedure. Call us to schedule an appointment to explore our surgical procedures for a bulging disc and find pain relief.
What is a Bulging Disk?
A bulging disk happens when a disc between two vertebral bodies is compressed and swells out of its position. A bulging disk is not the same as a herniated disk in that a herniated disc is when the internal disc material protrudes via cracks into the external disc layers. In contrast, a bulging disk is when the whole disc degenerates, becoming displaced to a given extent from its usual position.
Bulging discs become an issue when they infringe on fragile neural elements like nerve roots or the spine. Bulging disc-related pain can arise when the disk exerts pressure on the nerves, or the disc is inflamed.
The disks between the vertebrae have fluid that protects and holds them in position. As a person ages, they lose part of this fluid, causing the disks to shift from their position. Whereas any disc along the spine can bulge, disc bulging is prevalent in the lumbar region (lower back).
Disks can also bulge due to injury or trauma, like in a vehicle accident, by conditions such as arthritis, infection, or illness. Bulging disc symptoms may include tingling in the buttocks or legs, leg or arm weakness, limb numbness, and lower back, arm, and neck pain.
Surgery for Bulging Disc
Surgery is conducted to relieve the nerve pressure caused by the bulging disc. However, surgery is not the only treatment option for a bulging disc. Your doctor may explore various conservative treatment options; surgery will always be the last resort.
Depending on your condition, various non-surgical treatment options like physiotherapy, anti-inflammatory drugs, core strengthening exercises, postural training, massage, or chiropractic braces or treatment can be enough to relieve pain due to a bulging disc.
For example, if you experience just mild pain due to the bulging disc, non-surgical treatments are ideal. If your bulging disc does not respond to these treatments, your physician may recommend a minimally invasive surgical solution.
When Surgery Is an Option
As mentioned, surgery should be your last option to treat a bulging disc. However, surgery can be mandatory if the bulging disc symptoms have worsened. For example, you may need surgery if you are losing function or feeling in one of your body parts, like the feet or legs, or if you experience chronic back pain and non-surgical treatment options have not successfully relieved the pain. Surgery could be mandatory in these situations to avert permanent nerve damage.
Chronic bulging disc symptoms that would show surgery is necessary are:
- Pain when twisting the impacted area, bending, or lifting.
- Reflex changes can lead to spasticity.
- Changes in bowel and bladder function.
- Tingling, numbness, weakness, or pain in the extremities.
- Waist-down paralysis.
Types of Bulging Disc Surgical Procedures
There are various surgical procedures for bulging discs. What procedure a doctor will recommend depends on the patient's case. Doctors may opt for one of the various minimally invasive procedures or recommend open surgery. Minimally invasive procedures are the most commonly performed currently. Some of the minimally invasive procedures for a bulging disk include the following:
Nerves exit and enter the spinal canal via special gaps in the spinal joints known as foramina. Foramina can become narrowed by bone overgrowth or a bulging disc. Foraminotomy is a procedure conducted to reopen the foramen and relieve pressure.
During the procedure, you will lie face-down, and the doctor will administer the anesthesia and IV sedation. During the surgical procedure, a medical professional will carefully observe your vital signs, such as blood pressure and heart rate. Your doctor will then make a small incision beside your spinal cord on the side on which you are experiencing symptoms. They will make the incision at the level of the affected vertebra. The doctor will utilize a microscope and X-rays to guide the surgical procedure.
Using special instruments, your doctor will push away the back muscles adjacent to the spine to uncover the blocked foramina. They will utilize small instruments to take out the blockage in the foramen, which, in this case, is the bulging disc. This relieves nerve pressure.
In some instances, the surgeon may conduct another surgical procedure at this point, such as a laminectomy to remove a section of the vertebrae. The combination of the foraminotomy and laminectomy procedures is known as a laminoforaminotomy. The doctor will then remove the instruments, place the back muscles in place, and close the incision.
A discectomy is a surgery to remove a section of the bulging disc that exerts pressure on the spine and the roots of the spinal nerve, causing pain, numbness, radiculitis, weakness, or tingling. Once a section of the bulging disk is removed, the pressure on the nerve roots and spine eases. Your doctor can use various techniques to remove the damaged disc.
With one technique, the doctor will make a small incision on your back, between the vertebrae, into the space with the bulging disc, and then insert a small tube via the incision. They will then insert tiny tools via the tube to extract a portion of the bulging disc. Or, the surgeon may use a laser to remove a portion of the disk. Unlike the open discectomy procedure, the doctor makes only a tiny incision and does not remove any muscle or bone.
A discectomy relieves pain that travels down the legs or arms due to compressed nerves. The procedure is less effective for relieving pain that is felt solely in the neck or back. Most people suffering from neck or back pain will likely relieve the pain with other treatment options like physiotherapy, arthritis medication, or weight loss.
Laminotomy or Laminectomy
The laminotomy procedure is performed to relieve pressure from the nerves. It is conducted to remove all or part of the lamina to relieve pressure on the nerve roots or spine resulting from a bulging disc by enlarging the spinal canal. The procedure is usually done as part of decompression surgery and could be done intermittently so that the primary cause of pain is addressed first. The laminotomy procedure is conducted under general anesthesia and requires staying in the hospital for one or two nights.
The surgeon monitors your blood oxygen level, blood pressure, and heart rate during the procedure. Once you are unconscious and cannot feel pain, the doctor will incise an area in your back over the impacted vertebrae and push the muscles away from the spine as required.
The doctor utilizes small tools to extract bone spurs and the necessary lamina. They will also remove the bulging disc and the pieces that have broken loose. The incision size may vary based on your body size and condition.
Minimally invasive surgical procedures generally utilize smaller incisions than open surgical procedures. Once the procedure is over, the doctor will remove the tools and close the incision. The doctor may recommend physiotherapy after laminotomy to enhance your flexibility and strength.
For spinal fusion, you will be under general anesthesia. The procedure entails the permanent fusing together of two or more vertebrae. The surgeon could achieve this by taking a bone graft from another body part or a donor. Spinal fusion could also involve using plastic or metal rods and screws to give more support. This will permanently immobilize that part of the spinal cord. Spinal fusion generally requires staying at the hospital for several days.
Artificial Disc Surgery
You will be under general anesthesia for artificial disk surgery. This procedure is often effective if only one disc is affected and the problem is in the lumbar spine. It is not an ideal choice if you have osteoporosis, arthritis, or if multiple discs have degenerated. For this process, the doctor accesses the injury area through a cut in the abdomen. The bulging disc is extracted and replaced with a human-made disc. Artificial discs are usually made from metal or plastic. You might have to stay under observation in the hospital for some days.
Before Bulging Disc Surgery
When contemplating surgery, consult an experienced neurosurgical or orthopedic surgeon for a second opinion on your condition. Before recommending one surgery over other treatments, your doctor may order imaging tests, including:
- Nerve conduction studies or electromyography to measure electrical impulses along muscles and nerves.
- MRI—MRIs produce 3D pictures of the nerve roots, spine, and the disks themselves.
- CT scan— this scan provides more comprehensive pictures of the spinal canal and adjacent structures.
- X-ray— x-rays produce clear images of your joints and vertebrae.
These tests will assist your surgeon in determining the ideal type of surgical procedure for you. Other critical factors include age, general health, and the bulging disc's location.
Preparing for Surgery
Follow any instructions your doctor will provide you with regarding preparing for surgery. General instructions include no drinking or eating after midnight the day before surgery. And if you smoke, try stopping at least briefly before the procedure.
Some prescription medications can increase the risk of complications, such as bleeding during surgery. Even though your doctor will provide you with specific guidelines, you should withhold the following medications for seven or more days before the surgery:
- Blood thinners like Plavix and aspirin.
- NSAIDs like Aleve, Ibuprofen, Advil, and Naproxen.
- Arthritis medications.
- Herbal medicines and vitamins since they could interact with anesthesia.
Talk to your doctor and surgeon about your medical condition and inform them of all the prescription medications you are taking for precise guidelines on using them after and before surgery.
After Bulging Disc Surgery
Once the surgery is over, the surgeon will transfer you to the recovery room for observation. Consulting with your doctor after surgery will inform your next move. Most patients can start walking therapy right after surgery and resume work and usual activities within a few days.
Recovery After Surgery
Since minimally invasive surgeries do not use large incisions, there is minimal muscle damage. This generally leads to less post-operative pain and a quicker recovery. The recovery period may vary based on a patient's condition and procedure. However, many patients can walk right after the procedure and resume daily activities within a few days.
Will I Need to Undergo Other Surgeries in the Future?
Bulging disc surgeries have high success rates, with about 90% of patients having good relief from chronic leg and back pain. But that does not mean the discomfort and pain cannot recur, mainly if there is excessive pressure or an injury to the site. Additionally, pain may originate from a different bulging disk in the future.
What Happens If a Bulging Disc Is Not Treated?
Most people have bulging discs but do not show symptoms, and the condition does not affect their lives in any way. However, for other people, the force that makes a disc push outwards makes it come into contact with the nearby nerve root exiting the spinal cord, and they experience acute pain. With time, pain becomes debilitatingly chronic.
After a disk bulges outward, it will not return to its original position within the vertebral boundaries. However, if you are experiencing debilitating pain from the bulging disc and do not treat it, the risk to you is continued deterioration of your quality of life since the pain will hinder your movement. You will need to stop doing activities and engaging in sports that you could have enjoyed your whole life. Limited mobility will likely have other health effects as well.
Find a Reliable Bulging Disc Surgeon Near Me
At Dr. George Rappard's Practice, our specialists use the most recent techniques to diagnose, treat, and manage spinal conditions and injuries like bulging discs. We treat even the most severe cases, offering various treatment methods, including surgery. If you wish to undergo bulging disc treatment, whether surgery or other treatment options, in Los Angeles, contact us at 424-777-7463 to discuss your condition.