Disc herniation is considered as one of the most common causes of lower back and leg pain, affecting a large amount of population every year. According to a study, published in The Spine Journal, it is reported that about 0-47% cases of low back pain (LBP) occur due to the herniation or degeneration of the lumbar disc. The lumbar disc herniation can be symptomatic or asymptomatic. However, it is more likely to be symptomatic in the patients of the age group of 40-45 years.
What is the anatomy of the normal lumbar disc?
The bones of your spine or back are called vertebrae, which are cushioned by the pads of tissues, are called discs. In our lower back, there are 5 lumbar vertebrae. The discs present in between the spine bone or vertebrae are flat and round, having 2 parts, outer part and inner parts. The outer part is called annulus, which is a tough covering, and also called as a capsule. The inner covering is called the nucleus, a spongy jellylike material. The main functions of the healthy discs are:
- To hold the vertebrae in the position.
- Controls the flexibility of the spine.
- To absorb the shock of the bones.
How do you develop a herniated disc?
The normal everyday pressure on the spine usually exerts force on the outer layer of the discs, and causes bulges. But, the discs get bulged abnormally, and ruptured when they are damaged due to the normal wear and tear, accidental injury, or any medical condition. So, when the damaged discs are ruptured and bulged, it is called herniated disc. The herniated disc can occur in any part of the spine, but mostly it occurs in the lumbar spine. Such abnormally bulged or ruptured disc may sometimes put pressure on the adjacent spinal nerve roots and spinal cord, which leads to pain, weakness and numbness in the lower back, legs and buttocks.
What are the risk factors of a herniated lumbar disc?
There are many factors which can increase the risk of herniated lumbar discs. Some of the most common factors are:
- Ageing process: Due to the ongoing loss of water and protein from the discs.
- Overweight: Excessive weight exerts stress on the spine, which further leads to the damage of the disc.
- Work pattern: Works patterns like sitting for long period, lifting heavy objects, heavy physical exertion, frequent bending, repetitive motion, experiencing constant vibration, etc., can increase the risk of lumbar disc herniation.
- Lack of physical exercise: Lack of exercise leads to reduced trunk muscle strength, and also loss of spine support.
- Past medical history: History of back surgery, injury to the back, or herniated disc.
- Heredity: Family history of disc herniation.
- Smoking: The people who smoke, have reduced the blood flow and nutrients to the disc, which makes them more prone to disc herniation.
What are the symptoms of herniated lumbar disc?
The patients having herniated disc in the lower back (lumbar) may experience the following symptoms:
- Low back pain
- Muscle cramp or tightness in the low back
- Tingling sensation in the feet or legs
- Sometimes the pain radiates down the leg (sciatica)
- Weakness in the legs and feet
- In extreme cases, there will be loss of control in the bowel and bladder
Seek immediate medical care if you experience the following symptoms:
- Loss bowel and bladder control.
- Back pain with vomiting or fever with a temperature of 101 degrees or more.
- Leg pain with weakness, tingling, or numbness, which does not reduce after 1 week of home care.
- Work related back injury which does not subside after 3-4 days.
- Back pain worsens in resting than when you are active.
- You should visit or contact your doctor if you start noticing the following symptoms:
- Back pain, with pain during urination.
- Blood in the urine.
What are the diagnostic tools used for Lumbar herniated disc?
You visit your doctor, your doctor will take the first step of a diagnostic procedure, by taking the complete medical history, and a thorough physical examination. To make a confirmed diagnosis, he/she may advise you the following tests:
- CT scans
- X-ray, (it is not so useful, but suggested if your doctor suspects any internal fracture, tumor, infection, or any damage).
Other diagnostic tests:
- Electromyogram and nerve conduction test: It is advised for the patients who shows the signs of pressure on the nerve root.
- Myelogram: It isespecially advised for the patients who are not eligible for MRI, like a patient who has a pacemaker, and also when the MRI report is not very clear.
- Discography: It is advised to rule out the problems associated with the discs. But it is used in rare conditions.
- Nerve block: It is done to evaluate nerve that is giving the problem.
What are the treatments for Lumbar herniated disc?
In most of the cases, the lumbar herniated disc heals on its own. That is why, the doctors try the non-surgical treatments first. When you visit your doctor, he/she will ask you to take a rest or reduce the activity, then to increase the activity gradually once you start recovering. Some of the common non-surgical treatments are:
- Heat or cold therapy: Cold or heat therapy is effective in the first 24-48 hours. It helps in reducing the swelling, pain, and muscle spasm. While doing the therapy, avoid direct contact of cold or heat to the skin; instead use a cotton cloth under it.
- Exercise: Your doctor will suggest some exercise to reduce the pain and strengthen your back.
- Physiotherapy: Physiotherapy is the best conservative revenue to cure the herniated limbar disc. It helps reduce the pain, other symptoms, and enhance the flexibility. The physiotherapy should go hand in hand with the medications. Your physiotherapist will work on you according to the doctor’s prescription.
- Medications:The medication usually used to treat the lumbar disc herniation are:
- Pain relievers, like Acetaminophen, and non-steroidal anti-inflammatory medication.
- Muscle relaxant.
- Spinal Injection is prescribed, when other medication does not work. It is beneficial when the leg pain is severe, and there is a weakness in the legs.
Surgical Treatment of Lumbar Herniated Disc (Low back pain):
Surgery should be the first option, when all the non-surgical treatments fail. Your doctor will consider the surgery in the following conditions:
- If you don’t get relief from the pain after the 4 weeks of non-surgical treatment, and the symptoms worsen than before.
- If you experience difficulty in motion, loss of sensation, and feel extreme weakness.
- If all the reports indicates that you must need a surgery.
According to a study, published in the International Journal of General medicine, if the symptoms of the lumbar herniated disc is not relieved after the 6 weeks of the conservative treatment, then surgical intervention is the best option for the rapid relief from all the symptoms and to the restore the function.
Undergoing any surgery related to your spine is a big decision. So, before heading to it, you should have the complete knowledge about the surgery, including all the advantages, and disadvantages of the procedure, and also should clarify all the questions you have by asking your doctor. You should never neglect to take a second opinion, or 3rd opinion, to take a fully informed and confirmed decision.
Laminotomy and discectomy:
Surgery is performed to relieve the leg pain and nerve pressure. During the procedure, the surgeon removes some or all parts of the intervertebral disc. Also, to have a better access and visibility of the herniated disc, your doctor may also perform Laminotomy, in which he/she removes the bone that covers the particular nerve. Nowadays, minimally invasive surgery is the popular option, which requires only a few small incisions and advanced instruments, instead of using bigger cuts and instruments.
The other most common surgeries for lumbar herniated disc are:
- Lumbar laminectomy
- Lumbar spinal fusion
- Lumbar spine surgery
- Pedicle screws and rods
What are the preventive measures of Lumbar disc herniation?
You can reduce the risk of lumbar disc herniation by adopting the following habits:
- Always maintain a healthy body weight according to your height and age, which will help lower the strain on your back.
- Regular exercise can help you strengthen the spine, and also maintain the body weight.
- Quite smoke, because the nicotine present in the cigarette can effect on your spine, interrupting in the blood flow and nutrients.
- Be careful in your posture. Avoid slouching and slumping.
Practice good posture while you walk and stand. Keep your shoulders, hips, and ears in a straight position when you walk or stand.
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Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.