Disc bulge or disc protrusion involves the weakening of the outer disc inside the spine allowing for the soft and spongy disc to protrude outside. The protrusion of the disc usually causes entrapment of the underlying nerves leading to common symptoms such as pain, numbness, tingling sensations and sometimes muscle spasms. The main goal for treatment of disc bulge is to relieve the symptoms and keep the disc in place to prevent nerve entrapment. Managements for disc bulge may involve conservative and aggressive approaches depending on the extent of protrusion and severity of the symptoms. Common treatments for disc bulge include:

Conservative Treatments for Disc Bulge

Most disc bulge does not require surgical approach and conservative treatments are already adequate to relieve the symptoms. These include:

• Rest
Rest is by far the simplest and most basic approach to manage the symptoms of disc bulge and it is easily done at home. Continuing activities such as prolonged sitting, standing, lifting, twisting and bending may increase the pressure in the spine contributing to more extensive disc herniation. Rest should involve lying on the back with pillows under the knees to reduce pressure in the disc.

• Medication therapy
Medication is another immediate approach for disc bulge to relieve pain and improve comfort. Non-steroidal anti-inflammatory drugs are given to relieve pain and inflammation. Antidepressants can also be given for neuropathic pain wherein pain sensations cannot be relieved by NSAIDs alone.

• Physical therapy
Physical therapy is another common treatment option for disc bulge. It initially involves traction to allow the disc to return to its original place. It also involves strengthening and stretching exercises to ensure flexibility of the back muscles.

• Chiropractic care
Chiropractic care is an alternative approach for disc bulge, which involves the manipulation of the spine to relieve nerve impingements. It is actually becoming popular since it is a non-surgical approach to relieve pressure on the nerves. Chiropractic care is also a good approach for disc bugle because it helps avoid surgery in the long run.

Aggressive Treatments for Disc Bulge

Some cases may require more advanced treatment modalities for disc bugle. Steroid injections are common procedures for patients who are not relieved, despite the use of NSAIDs and antidepressants. Steroid injections are injected directly to the affected disc to provide localized and immediate pain relief. Steroid injections are also indicated for patients who require medications, but cannot tolerate NSAIDs because of gastric irritation or ulcers.

Another aggressive approach for disc bulge is surgery. By far, it is the last treatment option for cases that do not respond to the above conservative approaches. Surgery may involve one or more of the following procedures:

• Laminectomy or the removal of the lamina in the spine to relieve pressure in the nerves and spinal cord

• Discectomy or the removal of the disc to relieve pressure on the nerves

• Spinal fusion or the permanent fusion of the affected spine to prevent reoccurrence of herniation and is only indicated for recurrent bulges.

Other procedures may also be done if deemed necessary. Aside from the above treatments, weight reduction and proper body mechanics are also taught to relieve tension and pressure on the back for a more holistic treatment.