Lumbar (low back) disc herniation is a common back problem. Descriptive terms for a disc herniation include “slipped” or “ruptured” disc. A lumbar herniated disc is a common cause of low back and leg pain (i.e. sciatica). Intervertebral discs, which act as the spine’s shock absorbers, are located in between each vertebra. A tire-like band, the annulus fibrosus, encases a gel-like substance, the nucleus pulposus.
Symptoms
Symptoms of a lumbar disc herniation may include:
- Dull or sharp low back pain intensified by bending, coughing, sneezing, or other movement.
- Muscle spasm or cramping.
- Sciatica (pain, burning, tingling, and numbness that extends from the buttock into the leg or foot).
- Leg weakness or loss of leg function.
How Does a Disc Herniate?
If the disc’s outer band cracks or breaks open, the gel inside the disc can leak out causing a herniated disc. The disc material may place pressure on nearby nerve roots or the spinal cord. Additionally, nuclear material releases chemical irritants causing nerve inflammation and pain.
Sudden stress, such as from an accident, can cause a lumbar disc herniation. Sometimes, a disc herniation develops gradually over weeks or months.
Factors that can increase the risk for disc herniation include:
- Aging. As you grow older, discs gradually dry out, losing their strength and resiliency.
- Lifestyle choices. Lack of regular exercise, not eating a well-balanced diet, being overweight, and tobacco use substantially contribute to poor disc health.
- Poor posture, incorrect and/or repetitive lifting or twisting can place additional stress on the lumbar spine.
Diagnosis
If you suspect you may suffer from lumbar disc herniation, an accurate diagnosis is required from a physician with expertise in spinal disorders. Steps in diagnosis may include:
- Medical history. The doctor inquires about symptoms, their severity, treatments you have already tried and the results.
- Physical examination. The physician will examine you for limitations of movement, balance problems, and pain. The physician will test your reflexes at the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
- Diagnostic tests. X-rays can help rule out other problems such as a tumor or infection. CT scans and MRIs may be required to obtain more detail about your spinal problem.
Nonoperative Treatment
Most lumbar disc herniations do not require surgery. Long-standing evidence suggests that pain associated with a herniated disc often diminishes without surgery within 4 to 6 months. Unfortunately, it is not possible to predict which cases will have natural resolution, and which will not. There are many nonsurgical treatments to help relieve symptoms. These include:
- Medications, such as an anti-inflammatory drugs to reduce swelling and pain, muscle relaxants to calm spasm, and occasionally painkillers (narcotic or non-naracotic) to alleviate pain.
- Heat/cold therapy, especially during the first 24 to 48 hours.
- Epidural corticosteroid injection(s) may help relieve significant low back and leg pain.
- Physical therapy, which may include gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function.
During physical therapy, patients will be instructed in proper posture and body mechanics, which may enhance healing and prevent further injury.
Surgical Treatment
If nonoperative treatment ineffective or if there is evidence of neurological deficit (i.e. leg muscle weakness), surgery may be required. The goals of surgery are to decompress nerve structures and, if necessary, to stabilize the spine.
- A discectomy removes either the part of the disc that is compressing nerve structures or the entire disc.
- A laminectomy removes the lamina (vertebral roof) to access disc material from behind that is compressing the spinal canal or nerves. If only part of the lamina is removed, the procedure is a decompressive laminotomy.
- Instrumentation and fusion are performed to stabilize the spine and may be combined with discectomy. Instrumentation (i.e. rods, screws, interbody devices) and fusion (bone graft) joins and stabilizes two or more vertebrae.
Spinal instrumentation and fusion are not always necessary for a first-time disc, single-level disc herniation. The empty space created by the discectomy may be filled with bone graft. There are different types of bone graft, including your own bone harvested from your hip.
Many surgeries can be performed in a minimally invasive operation. The surgeon will discuss surgical interventions that may be appropriate for you and associated risks and benefits.
Surgical Recovery
Most patients can begin to get out of bed on the same day surgery is performed. Activity is gradually increased and patients are typically able to go home shortly after their procedure, depending on the type and extent of the surgery. Some postsurgical pain is normal but can be controlled by pain medications.
Recovery at home will include rest and a gradual program of increasing activity, including strengthening exercises. Pain can be controlled with medication but should diminish within a week or two after surgery. The medical team will advise patients as to when normal activities and work can be resumed.