Spinal Disorders: Lumbar Disc Herniation

A lumbar (low back) disc herniation is a common problem.  Descriptive terms for a disc herniation include slipped or ruptured disc.  Herniated discs are regularly treated in our practice.

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 (annulus fibrosis) encases a gel-like substance, the nucleus pulposus.

Lumbar disc herniation

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.

herniated disc

Sudden stress, such as from an accident, can cause a lumbar disc herniation.  Sometimes, a disc herniation develops gradually over weeks or months.

disc degeneration

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 over-weight, 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

Our comprehensive diagnostic process includes:

  • Medical history.  You doctor talks to you about your symptoms, their severity, and treatments you have already tried.
  • Physical examination.  You are carefully examined for movement limitations, balance problems, and pain.  During your exam, the doctor evaluates loss of extremity reflexes, muscle weakness, loss of sensation, or other signs of a neurological problem.
  • Diagnostic tests.  Generally, the doctor starts with plain x-ray films, which help rule out other problems such as a tumor or infection.  CT scans and MRIs are performed 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 4-6 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 to reduce swelling and pain, muscle relaxants to calm spasm, and occasionally narcotic painkillers to alleviate acute pain.  
  • Heat/cold therapy, especially during the first 24-48 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.

In conjunction with these treatments, our staff will educate you about healthy posture and proper body mechanics.

Surgical Treatment

If nonoperative treatment not effective, or there is evidence of neurological deficit (i.e. leg muscle weakness), we may recommend surgery.  The goals of surgery are to decompress nerve structures and stabilize the spine, if necessary.

  • 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.

Our practice performs many spine surgeries utilizing minimally invasive techniques.  Your surgeon will explain your procedure, how it will be performed, along with the benefits and possible risks.

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 within a day(s) after their procedure, depending on the type and extent of the surgery.  Expect some pain after the procedure. However, we have pain medications available that will keep you comfortable.

At home, you will need to continue to rest.  You will be instructed on how to gradually increase your activity.  You may still need to take the pain medications for a while.  However, pain and discomfort should begin to reduce within a week or two after surgery.   We will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home.  We will also discuss with you a timeframe for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as work, sports and yard work.

At our practice your return to health is our primary concern.  If you have any questions about your condition, your treatment, or your recovery, do not hesitate to call us.