You’ve probably heard the terms bulging disc and herniated disc before. And, chances are, you know they both have to do with something in your spine. You probably know both can be painful, too — but are they the same thing?

In a word: Nope. While they both affect the discs in your spine, bulging discs and herniated discs are not two terms for the same condition, explains Harvey E. Smith, MD, Penn Medicine physician and orthopaedic surgeon.

What’s the difference? Here’s what you should know about bulging discs vs. herniated discs.

Q: What Are the Key Differences Between a Bulging Disc and a Herniated Disc?

Dr. Smith: Your spine is made up of bones (called vertebrae) and rubbery discs stacked on top of one another, forming the spinal canal. The bundle of nerves (called the spinal cord) run down the length of the spinal canal.

The discs in your spine function like shock absorbers between the vertebrae. These discs are made of two components: a softer center (called nucleus pulposus) surrounded by a tough elastic-like band (called annulus fibrosus).

Q: What Causes a Bulging Disc and How Is It Treated?

Dr. Smith: As we age, our discs deteriorate and bulge downward, so bulging discs are usually caused by age-related degeneration.

Because it is considered degenerative, there is usually a progressive, gradual onset of symptoms. It can cause pain in the buttocks, legs, or back. It can also affect your ability to walk.

Bulging discs usually affect multiple discs. This condition develops over time and can cause other disc degeneration-related issues, like lumbar stenosis (narrowing of spinal canal).

Fortunately, there is a spectrum of treatment options. Short-term treatment can mean taking anti-inflammatory medications, especially during flare-ups. Steroid injections may be considered if there is significant nerve pain.

Long-term treatment usually involves a self-directed exercise program that you start with a physical therapist and then transition to doing at home.

If your bulging discs have caused lumbar stenosis and the symptoms are affecting your quality of life, surgery (called lumbar decompression) is an option. The procedure is very patient-specific based on the type and level of stenosis, but, in general, it involves decompressing the spinal canal so that the nerves are no longer compressed. This, in turn, relieves the pain.

Q: What Causes a Herniated Disc and How Is It Treated?

Dr. Smith: Pain from a herniated disc comes on abruptly and usually affects one individual nerve root. Herniated discs are sometimes caused by an acute injury.

In some cases, you may know the cause of the injury, such as twisting incorrectly. Other times, I see patients who just woke up one day and noticed this pain in their back.

As with bulging discs, there is a spectrum of options to treat herniated discs.

If you’ve experienced symptoms for less than 6 weeks and have no nerve damage, anti-inflammatory medications, physical therapy, and steroid injections (if needed) can help resolve the issue in 6 to 12 weeks.

If those don’t work, an outpatient surgery called a microdiscectomy can alleviate pain quickly by relieving the pressure on the affected nerve root.

Q: What Should Patients Know About How Penn Medicine’s Spine Center Treats Both of These Conditions?

Dr. Smith: Within the Spine Center, our multidisciplinary approach allows us to care for most patients without surgery, from start to finish. We also have a surgery team in place so that patients who come to us initially who end up needing surgery can receive that continuity of care.

In terms of technology, we’re at the forefront of adopting and implementing new technologies and minimally invasive surgical techniques.

But the good news is that oftentimes, if this is the first time you’ve had either a bulging or herniated disc, it can be managed without surgery. From bulging discs to herniated discs and everything else spine-related, find out how Penn Medicine’s Spine specialists can help your pain. 

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