WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREENING AND DIAGNOSIS

A disc bulge without other pathology will not be identified at all on an X-ray study. If there is some associated age-related disc degeneration, an X-ray study may reveal reduced disc space height between vertebrae. There may be signs of arthritis with bone spurs and enlargement of the spinal (facet) joints. CT assessment may confirm the generalized extension of the outer portion of the disc beyond the boundary of the adjacent vertebrae. MR imaging is the most revealing of the imaging tests for disc bulge. It typically presents with reduced signal on T2 weighting consistent with some disc degeneration. It may reveal thickening of some of the spinal ligaments and degenerative joint changes. MRI may reveal tears of the disc fibers (annulus) if present.

A disc bulge needs to be differentiated from other conditions including:

• Disc Protrusion
• Ossification (Calcification) of the Posterior Longitudinal Ligament
• Vertebral Bone Spur

CAUSES

The may be genetic predisposition to developing disc degeneration and associated disc bulge. Environmental factors such as heavy lifting, rotation, repetitive flexion-extension and injury can lead to disc fiber compromise and generalized disc bulging. Age related change sin the water content of the disc as ell as the biochemical composition of the disc can lead to disc bulging. Poor posture and repetitive physical microtrauma can also lead to a disc bulge. Any condition which promote disc degeneration such as reduced nutrient supply to the disc secondary to degenerative endplate changes. Increased loads place upon a disc can lead to temporary disc bulging secondary to pressure placed down upon the disc.

NATURAL HISTORY AND PROGNOSIS

Most disc bulges are not associated with symptoms and represent a normal disc state. If there are bone spurs, thickening of spinal ligaments of spinal joint enlargement (facet hypertrophy) there may be crowding of the central or lateral spinal canal. This would leave less room for a spinal nerve if the disc bulges. The presence of other spine disorders can increase the risk for symptoms in the presence of a large disc bulge. When the condition is associated with symptoms they usually respond to conservative care. A small percentage of individuals may go on to develop chronic or progressive neurological involvement. Most disc bugles are not progressive and not associated with disc herniation. If a disc bugle is associated with annular tears undetected by imaging, the condition is more likely to progress to a disc herniation with further compromise. It will be recognized by advanced imaging at a later date.