Spinal Pain: Surgery or Tough It Out

Back pain can be debilitating and it can occur at any age and at any time. At times, the pain is a direct result of a traumatic incident, like a car crash, a fall, or even pregnancy. Oftentimes, back pain starts without any perceivable correlating or causative event. You can suffer with back pain at a young age or it can start later in life. Research has shown that about 41% of adults with back pain are 18 to 44 years old¹.

No matter when or how back pain appears, it can severely impact your quality of life. Recent studies have shown that 8.2% of American adults have chronic severe back pain, and nearly 75% of those with chronic severe back pain have difficulties with mobility, social participation, self-care, or work participation². An estimated 75-85% of Americans experience some form of back pain during their life and 50% of patients who suffer from episodes of low back pain will have recurrent episodes within one year³.

Herniated vs. Bulging Discs: One Slips, the Other Stretches

The spine is made of vertebrae, small bones that are cushioned in between with discs. Discs are rounded pillows with a tough outer layer of cartilage which surrounds the softer nucleus in the center. These discs act as shock absorbers for the spinal bones.

Among the most frequent causes of back pain are herniated or bulging discs, both of which can lead to persistent discomfort, nerve pain, and reduced mobility.

A herniated disc is one that has ruptured from the middle into the spinal canal. It happens when a fragment of the nucleus is pushed out of disc’s outer layer through a tear or a rupture. The nucleus becomes lodged into the spinal canal. The spinal canal has limited space for both the spinal nerve and the displaced herniated disc fragment. Due to this displacement, the disc presses on spinal nerves which is what produces the back pain. Herniated discs can occur in any part of the spine but are most common in the lower back (lumbar spine)⁴. Herniated discs are also referred to as slipped discs because the center of the disc is has “slipped” from its place into the spinal canal.

One simple traumatic or stressful event can cause a herniated disc, but disc material can also degenerate as one ages. Once the degeneration begins, even a minor strain or twisting movement can cause a ruptured (herniated) disc.

Bulging discs are different than herniated discs. A bulging disk looks a little like a hamburger that’s too big for its bun or when a balloon starts to push outward but doesn’t pop. Usually, at least a quarter to a half of the disk’s circumference is affected. And only the outer layer of tough cartilage is involved, unlike a herniated disc where a crack in the outer disc later causes some of the soft center of the nucleus to slip out⁵.

Both herniated and bulging discs can be very painful and debilitating. Symptoms can also include tingling or numbness in extremities, radiating pain, sciatica, episodes of muscle weakness, and occasionally loss of bladder control. Discomfort can worsen with certain activities like sitting, standing or bending.

Pain Differential:

The primary difference between herniated and bulging discs is in your symptoms and their severity. A bulging disc is generally less severe than a herniated disc since the outer layer remains intact. The rupture of the outer layer of the disc which charaterizes a herniated disc can lead to more intense symptoms, including severe pain and neurological symptoms.

Diagnostic Tests:

In order to know whether your disc is herniated or bulging, radiology plays a key role in diagnosing the cause of your back pain. The following radiological diagnostic tests are the most common to identify the condition:

• X-rays or a myelogram, the latter of which is an X-ray that includes injection of contrast into the surrounding cerebrospinal fluid spaces
• CTs or CAT scans
• MRIs
• Electromyogram and EMG studies which measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue.

Treatment Options:

While herniated discs sound more severe than bulgings ones, there are treatment options without surgery. Both conditions can respond well to conservative treatments like physical therapy, lifestyle modifications, anti-inflammatory medications, epidural injections or radio frequency abelation.

Spine surgery has been used to treat degenerative and non-degenerative diseases of the spine when conservative treatment has failed, and the number of spinal surgeries has significantly increased in recent years, in some cases more than 50%. One study revealed that about 8%–40% of patients who undergo lumbar spine surgery may develop intractable or recurrent leg pain and back pain after surgery⁶. Another study reported that the success of spinal fusion surgery (a procedure to stabilize the spine) to treat lumbar pain can vary from 65 to 100%, depending on comorbidity factors, such as rheumatoid arthritis, osteoporosis, or smoking⁷. Some have reported that, over a period of time, patients have shown a 30% reduction in disability and pain after spine surgery⁸.

Studies among orthopedic surgeons, neurosurgeons, pain specialists, and other health care professionals have shown that 84.7% chose conservative care as their first-choice. About 36% chose surgery alone, and 48.5% preferred a combined program of physical and psychological therapy⁹.

Whether to Opt-In or Out:

Every medical situation is different. Patient pain levels differ, ability to manage their pain differs, their age matters, and their comorbidities are relevant. Surgery of any kind requires a period of recovery and success rates are not guaranteed. Less invasive and more conservative approaches have been shown to be successful and can be considered before you opt-into surgical ones.

A second opinion may help in giving you peace of mind as you navigate your options in alleviating your back pain. If you have been suffering from back pain and want a second opinion to review your diagnostic tests, contact us.