What causes disc prolapse or bulging discs in young women?

Causes of Disc Prolapse or Bulging Discs in Young Women

The primary causes of disc prolapse or bulging discs in young women include repetitive mechanical stress, sports-related activities, skeletal dysplasia, and pregnancy-related anatomical changes.

Mechanical and Activity-Related Factors

• Repetitive mechanical stress from activities involving compression and bending is a major cause of disc prolapse in young women, as these forces create stress concentrations in the posterior annulus that predispose discs to failure 1
• Competitive athletic activities significantly increase the risk of spine injuries including disc degeneration and prolapse, particularly in sports that place biomechanical stress on the spine 2
• Specific high-risk activities include weightlifting, wrestling, soccer, track and field, baseball, tennis, and gymnastics, each creating different biomechanical stresses on the lumbar spine 2
• Young soccer athletes are prone to injuries from compressive stress from running, while baseball players experience injuries from high rotational and torsional forces 2

Anatomical and Structural Factors

• Degenerative changes in intervertebral discs significantly affect their kinematic behavior under postural load, with moderately degenerated discs (grades III and IV) demonstrating greater bulging than mildly degenerated discs 3
• Extension posture results in significant posterior disc bulging in degenerative discs, while flexion does not demonstrate obvious anterior derangement 3
• In young women with isthmic spondylolisthesis, extreme lateral disc herniation (foraminal or extraforaminal) occurs in approximately 30% of cases, which is a higher incidence than in the general population 4
• The process of disc prolapse often begins with distortion of annular lamellae forming radial fissures, followed by extrusion of nuclear pulp into the spinal canal 5

Pregnancy and Childbirth-Related Factors

• Pregnancy and childbirth can contribute to disc problems through mechanical changes in the spine and pelvis 2
• Softening of the symphysis pubis and sacroiliac joints during pregnancy can lead to longer-term symphyseal or pelvic girdle pain, potentially altering spinal mechanics 2
• Postpartum low back pain is a common chronic condition affecting more than 10% of women beyond 6 weeks after birth 2

Genetic and Congenital Factors

• Skeletal dysplasia can contribute to disc prolapse in young women through abnormal structure of vertebrae, resulting in significant stenosis of the spinal canal 2
• Women with skeletal dysplasia often have irregularly shaped vertebral bodies that may be flatter than usual and anatomically of different sizes, resulting in scoliosis and kyphosis 2
• Prolapse of intervertebral discs and thickening of interspinal ligaments may result in further narrowing of the spinal canal in women with skeletal dysplasia 2

Clinical Presentation and Diagnosis

• Disc prolapse in young women may present with back pain, radicular symptoms, or in rare cases, abdominal wall paresis or bulging 6
• Radiography is useful as first-line imaging for evaluation of back pain, but MRI is the modality of choice when there is clinical suspicion for disc pathology 2
• MRI without contrast is typically sufficient for evaluation of disc prolapse, as contrast administration is primarily useful for suspected infection, inflammation, or neoplasm 2
• Routine imaging is not recommended for acute uncomplicated low back pain (less than 4 weeks duration) without red flags, as it provides no clinical benefit and may lead to increased healthcare utilization 2

Important Considerations and Pitfalls

• Nonspecific lumbar disc abnormalities are common in asymptomatic patients and can be readily demonstrated on imaging, making it important to correlate imaging findings with clinical presentation 2
• A substantial number of people without back pain have imaging abnormalities, with disc protrusion prevalence increasing from 29% in 20-year-olds to 43% in 80-year-olds in asymptomatic populations 2
• Repeat imaging in patients with new episodes of low back pain and previous MRI scans are unlikely to detect differences in disc protrusion, annular fissures, high-intensity zones, or end-plate signal changes 2
• The majority of disc herniations show some degree of reabsorption or regression by 8 weeks after symptom onset, suggesting that conservative management may be appropriate initially 2