Herniated Lumbar Disc
Spinal discs play a crucial role in the lower back, serving as shock absorbers between the vertebrae, supporting the upper body, and allowing a wide range of movement in all directions.
If a disc herniates and leaks some of its inner material, though, the disc can quickly go from easing daily life to aggravating a nerve, triggering back pain and possibly pain and nerve symptoms down the leg.
Disc herniation symptoms usually start for no apparent reason. Or they may occur when a person lifts something heavy and/or twists the lower back, motions that put added stress on the discs.
Lumbar herniated discs are a widespread medical problem, most often affecting people age 35 to 50.
How a Lumbar Disc Herniates
A tough outer ring called the annulus protects the gel-like interior of each disc, known as the nucleus pulposus.
Due to aging and general wear and tear, the discs lose some of the fluid that makes them pliable and spongy. As a result, the discs tend to become flatter and harder. This process—known as disc degeneration—starts fairly early in life, often showing up in imaging tests in early adulthood.
When pressure or stress is placed on the spine, the disc’s outer ring may bulge, crack, or tear. If this occurs in the lower back (the lumbar spine), the disc protrusion may push against the nearby spinal nerve root. Or the inflammatory material from the interior may irritate the nerve. The result is shooting pains into the buttock and down the leg.
Symptoms of a lumbar herniated disc vary widely—from moderate pain in the back and buttock to widespread numbness and weakness requiring immediate medical care.
In the vast majority of cases, the pain eases within six weeks. But despite its short duration, the pain can be excruciating and make it difficult to participate in everyday activities and responsibilities. For some, the pain can become chronic and/or debilitating.
These are some general characteristics of lumbar herniated disc pain:
- Leg pain. The leg pain is typically worse than low back pain. If the pain radiates along the path of the large sciatic nerve in the back of the leg, it is referred to as sciatica or a radiculopathy.
- Nerve pain. The most noticeable symptoms are usually described as nerve pain in the leg, with the pain being described as searing, sharp, electric, radiating, or piercing.
- Variable location of symptoms. Depending on variables such as where the disc herniates and the degree of herniation, symptoms may be experienced in the low back, buttock, front or back of the thigh, the calf, foot and/or toes, and typically affects just one side of the body.
- Neurological symptoms. Numbness, a pins-and-needles feeling, weakness, and/or tingling may be experienced in the leg, foot, and/or toes.
- Foot drop. Neurological symptoms caused by the herniation may include difficulty lifting the foot when walking or standing on the ball of the foot, a condition known as foot drop.
Lower back pain. Lower back pain may be present, but not always. The low back pain may be described as dull or throbbing, and may be accompanied by stiffness. If the herniated disc causes lower back muscle spasm, the pain may be alleviated somewhat by a day or two of relative rest, applying ice or heat, sitting in a supported recliner or lying flat on the back with a pillow under the knees.
- Pain that worsens with movement. Pain may follow prolonged standing or sitting, or after walking even a short distance. A laugh, sneeze, or other sudden action may also intensify the pain.
- Pain that worsens from hunching forward. Many find that positions such as slouching or hunching forward in a chair, or bending forward at the waist, makes the leg pain markedly worse.
- Quick onset. Lumbar herniated disc pain usually develops quickly, although there may be no identifiable action or event that triggered the pain.
Surgery for herniated lumbar disc
If the pain and other symptoms of a lumbar herniated disc persist after six weeks, surgery is often considered. A lumbar herniated disc is the most common reason for spine surgery in adults during their working years.
Surgery may be recommended if:
- There is severe pain and the person is having difficulty maintaining a reasonable level of daily functions, such as standing or walking.
- The person is experiencing progressive neurological symptoms, such as worsening leg weakness. and/or numbness
- There is a loss of bowel and bladder functions.
- Medication, physical therapy, and/or other nonsurgical treatments have not significantly eased symptoms.
In some cases, surgery is needed before the patient has completed six weeks of nonsurgical care.
Two minimally invasive procedures, microdiscectomy and endoscopic microdiscectomy, are most commonly recommended for lumbar herniated discs. These procedures take the pressure off the nerve root and provide a better healing environment for the disc.
Usually, only the small portion of the disc that is pushing against the nerve root needs to be removed, and the majority of the disc remains intact.
Small incisions are used in a microdiscectomy. For endoscopic microdiscectomy surgery, instruments are inserted through a thin tube or tubes to minimize disruption to the surrounding tissue. A tiny camera can be inserted through a tube to provide visualization for the surgeon.
Both types of surgery are usually performed on an outpatient basis or with one overnight stay in the hospital. Most patients can return to work and their regular routines in one to three weeks.
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