Bulging VS. Ruptured Disk VS. Herniated Disk

Bulging disk. Herniated disk. Ruptured disk.

All three of these terms tend to strike fear into the heart, especially among patients suffering from back pain. To make matters even more confusing, patients often use these terms interchangeably, when in fact they are three terms that describe two very distinct conditions.

In this Polaris Mythbuster, Dr. Raymond Walkup pulls back the veil on these terms, discusses the conditions they actually refer to, and talks about ways to treat them.

Raymond Walkup, M.D., of Polaris Spine & Neurosurgery Center in Atlanta, Georgia.

Myth #1: Bulging, herniated, & ruptured disks are the same.

Reality: Bulging disks and herniated/ruptured disks are different conditions.

Dr. Raymond Walkup, M.D., spine surgeon at Polaris Spine & Neurosurgery Center, explains that the terms ruptured disk and herniated disk are in fact interchangeable, but a bulging disk is a different matter. “A bulging disk just means that the soft disk between the bones of your spine is bulging outward,” he says. “You press down on it, and it flattens out, it gets wider, sometimes in all directions… A herniated disk is different. A herniated disk means that a piece of the soft inside of the disk escapes out of the normal disk space. The lining around the disk called the annulus gets torn. Then that can press on nerve roots in the spinal cord and cause pain.”

Dr. Walkup further explains that while both conditions can cause back pain, the type of pain between bulging and herniated disks occurs much differently. “A disc bulges very slowly,” he says, “usually over a long period of time, over several months to even several years. A herniation is something that happens suddenly. It can happen in cases of trauma like a car wreck, or a fall, weightlifting or even spontaneously—it just happens. Also, when a disk herniation happens, it’s extremely painful. With a ruptured disk, it can be so horribly painful that a lot of patients will remember specifically the date and the time that it started.”

Myth #2: Bulging and herniated disks must be corrected surgically.

Reality: Bulging disks rarely require surgery; herniated disks, only occasionally.

“Bulging disks are very, very common,” says Dr. Walkup. “In a lot of cases, bulging disks are just a natural part of the spine aging…If you got an MRI of the lumbar spine on everyone in Georgia aged 55-65, probably 80-90 percent of them are going to have bulging disks. And once a disk bulges, it’s bulged–it doesn’t really regenerate itself so to speak. It can cause back pain, but usually that pain can be treated with something like physical therapy or chiropractic care, maybe steroid injections.

“For herniated disks, even though they are extremely painful the first several days or weeks, in most cases a disk herniation can eventually just shrivel up on its own. In the meantime, we’ll try things like physical therapy, exercises or steroid injections just to try to settle down the inflammation. If it’s been six weeks or twelve weeks and someone is still having a significant amount of pain, then we have to consider surgery at that point.”

Spinal Disk Conditions: The Bottom Line

Most people will experience some form of disk bulging as they age, although Dr. Walkup says patients can reduce the risk by watching their weight and maintaining their core strength through regular activity. Bulging disk pain usually comes on gradually and is treatable by non-surgical means. Disk herniation is a more acute condition that can cause extreme pain at the beginning, but it often resolves itself gradually. Only patients who don’t see the pain reduce over time usually become candidates for surgery.

Why Polaris Spine & Neurosurgery Center?

A spine specialist, like one of our doctors, is the best person to diagnose your back or leg pain to determine whether you’re suffering from a bulging disk, herniated disk, or some other back/spine condition.

At Polaris Spine & Neurosurgery Center, our team of spine doctors and specialists take a holistic approach to treating spinal pain in patients — one that involves physical therapy, exercise, chiropractic care, and, in some cases, epidural or steroid injections. We recommend surgery only when it is absolutely necessary, and those recommendations are based on a thorough analysis of the patient’s unique medical history, physical exams, and radiological studies.

If you’re experiencing back and/or leg pain, call Polaris Spine and Neurosurgery Center at 404-256-2633 for an evaluation.


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