Lumbar Disc Herniation
Lumbar disc herniation is a common cause of low back and leg pain. Terms to describe disc problems include bulging, ruptured, slipped, or extruded. Sometimes a disc herniation occurs spontaneously or incidental to injury, repetitive movements, or degenerative disc disease.
The lumbar intervertebral discs serve as your low back's shock absorbers. Each disc is composed of a sturdy tire-like annulus fibrosis that encases a gel-like interior called the nucleus pulposus. Endplates anchor each disc in place between two vertebral bodies.
Growing older, trauma, injury, smoking, poor diet, being overweight, and wear and tear can alter disc strength, resiliency and structural integrity.
What happens
The annulus fibrosis—the protective band of tissue protecting the nucleus pulposus—cracks, tears, or breaks open. This allows some of the gel-like nuclear material to ooze outside the disc. A bulging disc—the nucleus pulposus remains contained within the disc—may be a precursor to herniation. Escaping disc matter may cause:
- Nerve root compression
- Spinal canal compression
- Both
Symptoms
Pain is the foremost symptom of a lumbar herniated disc. The disc material, and potential loss of disc height, compresses the spinal nerves and/or canal. Furthermore, within the escaping disc matter is a chemical irritant that causes nerve inflammation and pain. Back pain may spread into your buttocks and legs and present with sciatica. Leg pain may be described as radicular pain or a radiculopathy. Sometimes pain is felt in the hip(s).
- Pain, mild to intense
- Movement increases pain
- Sensations: burning, tingling, numbness, pins and needles
- Difficult and painful to walk, stand, bend forward, backwards, side-to-side
- Rare, bowel and bladder dysfunction
Accurate diagnosis
Consult an expert, especially if back pain develops suddenly, quickly worsens, or you have a pre-existing back disorder. An accurate diagnosis is essential to an effective and successful treatment plan.
Your medical history and physical and neurological examinations are very important. You and your doctor discuss your symptoms, when they developed, and treatments tried. The doctor tests your reflexes and evaluates you for muscle weakness, loss of feeling, and signs of neurological injury.
Diagnostic tests help the doctor confirm which lumbar disc (or discs) is damaged. A simple spinal x-ray can show collapsed disc space. CT and MRI are sensitive imaging tools that detail bone, disc and nerve structures.
Treatment options
Non-surgical treatment often helps to relieve pain and symptoms. Your doctor may combine two or more therapies to maximize the success of your treatment.
Non-surgical treatments include:
- Activity modification
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Pain medication (a narcotic, painkiller)
- Muscle relaxing medication
- Spinal injection
- Short-term lumbar bracing supports the spine, may help relieve pain
- Physical therapy
- Acupuncture
When your surgeon may discuss surgical treatment
- Spinal instability
- Neurologic dysfunction
- Pain and symptoms are unrelenting
- Non-operative treatment fails and pain persists
Surgical treatment
You may be a candidate for a minimally invasive spine surgery. Sometimes spinal stabilization and fusion are necessary to stop the spine from moving or help alleviate progression of symptoms. Lumbar interbody fusion can be performed through the front, back or side of your spine. It is an example of a type of minimally invasive spine surgery used to treat lumbar disc herniation and stabilize the low back.
Keep in mind that spine surgery is not always necessary. However, if your surgeon discusses surgical options with you, be assured his recommendation is made with the greatest concern to your healthcare. |
