The lumbar intervertebral discs are flat and round, present between the lumbar vertebrae and act as shock absorbers when you walk or run. There is a soft, gelatinous material in the center (nucleus pulposus) which is encased in strong elastic tissue forming a ring around it called annulus fibrosus.
Herniated disc is a condition in which the outer fibers (annulus) of the intervertebral disc are damaged causing the soft inner material of the nucleus pulposus to rupture out of its space. A herniated disc, common in the lower back (lumbar spine) occurs when there is a tear in the outer lining of the disc (annulus fibrosus). This causes the inner jelly-like material (nucleus pulposus) to leak out and place pressure on the adjacent spinal nerve root. It is the most common cause of low back pain and pain that radiates down the leg (radiculopathy or sciatica).
Ageing, injury or trauma may cause the annulus fibrosus to tear resulting in protrusion of the nucleus pulposus. This may compress the spinal nerves and/or spinal canal. The bulging disc may even break open releasing the gelatinous material, which is a chemical irritant, causing inflammation of the spinal nerves.
Obesity, sedentary lifestyle and smoking increase the risk of lumbar disc herniation.
The most common signs and symptoms of lumbar disk herniations are back pain that radiates to buttocks and legs, numbness in the leg or foot, weakness in the leg or foot, and rarely loss of bowel and bladder control.
The symptoms of lumbar disc herniation include:
Proper diagnosis of the condition requires a complete medical history and a careful physical and neurological examination by your physician. Neurological examination is done to indicate any neurological injury and involves evaluation of reflexes and muscle weakness by various tests. Some of the additional diagnostic tests your doctor may suggest include:
Non-surgical treatment is preferred over surgery and includes rest, pain medications, physical therapy, and avoiding strenuous activity if the pain is severe. Pain medication can include non-steroidal anti-inflammatory drugs, muscle relaxants and epidural analgesic injections. Back braces are recommended for a few days to keep the lower back still and reduce mechanical pain due to movement. Physical therapy or acupuncture may be helpful in some cases.
Epidural Steroid Injection (ESI): ESI can be considered if the pain is intolerable even with medications and rest.
Surgery is considered in cases with significant leg pain, muscle weakness and numbness that is unresolved after conservative treatment measures. Urgent surgery may be required if neurologic dysfunction or cauda equine syndrome occurs.
Lumbar microdiscectomy is the most commonly used surgical procedure done to remove a herniated part of the disk and any fragments that are putting pressure on the spinal nerve. This surgical procedure involves use of a surgical microscope and microsurgical techniques to gain access to the lumbar spine. The microscope magnifies and illuminates the area of operation. Only a small portion of the herniated disc that pinches on the nerve roots is removed.
It is a comparatively safe procedure but some of the risks include infection, nerve damage, dural leak, or hematoma. Most patients undergoing surgery find significant respite in pain after the surgery. Talk to your surgeon about any concerns you have about surgery.
