Lumbar Disc Herniation

The causes of lumbar disc herniation include but are not limited to:

• Age-related wear and tear: Known as disc degeneration, this process involves the intervertebral discs drying out and collapsing, which leads to tears and fissures, facilitating disc herniation. Localized irritation and inflammation of a nerve root lead to localized back pain. Disc collapse leads to changes in the alignment of the vertebrae that, over time, will create bone spurs that can pinch the spinal cord or nerve roots.
• Physical strain: A single excessive physical strain due to occupation, heavy lifting, sudden pressure, or twisting movements, as well as even a minor strain or twisting, can cause tears or ruptures in a degenerated disc.
• Trauma: Accidents or falls can precipitate a herniation.
• Genetics: A predisposition to disc degeneration can be inherited.
• Risk factors: Obesity, smoking, being sedentary, and driving frequently.

Symptoms of lumbar disc herniation can vary depending on the location and severity of the herniation but commonly include:

• Low back pain is often the first symptom experienced. If a nerve is not involved, the pain may be just a low backache. Sometimes, a herniated disc will not cause any pain.
• Sciatica: Pain that radiates from the back down through the buttocks and into the legs, often with a sharp, tingling, or burning pain that may, at times, feel like an electric shock. Sciatica pain may be more severe when standing, sitting, or walking.
• Numbness or tingling: These sensations can occur in the areas served by the affected nerves.
• Muscle weakness: Muscles served by the affected nerves may weaken, affecting mobility.
• Loss of bowel or bladder control: This is a rare but serious condition known as cauda equina syndrome, which requires immediate medical intervention.

Dr. Ball will review your medical history and evaluate your symptoms. He will inquire about when the pain began, the quality of the pain, your activities and which activities cause pain, and how your pain affects your daily life. He will perform a neurological evaluation to identify the level of lumbar herniation that is causing pain and test for sensory abnormalities, weakness, radiating pain, and sciatica. He will also use certain physical maneuvers to elicit symptoms.

Dr. Ball may order lab tests and X-rays to view the spinal vertebrae and their alignment. Narrow intervertebral spaces and bone spurs are visible and suggest disc herniation. An MRI is the gold standard to confirm a herniated lumbar disc.

Over 85% to 90% of patients with an acute herniated disc experience relief of symptoms within 6 to 12 weeks without any treatments. Initial therapy is conservative and nonsurgical unless red flags are present, including progressive neurological problems, including foot drop, tripping, and cauda equina syndrome, which includes numbness in the genital and anal area, and bowel and/or bladder control compromise. Red flags indicate the need for surgical intervention.

Treatment for lumbar disc herniation focuses on relieving pain, restoring function, and preventing further injury. The options include:

Conservative Treatments:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, or muscle relaxants can help reduce inflammation and pain.
• Physical Therapy: Tailored exercises can improve flexibility and strength, relieve pressure on the nerve root, and promote better spinal alignment.
• Epidural Steroid Injections: Corticosteroid injections near the affected area can help reduce pain and inflammation temporarily.

Surgical Treatments:

• Microdiscectomy: A common procedure where the portion of the herniated disc pressing on the nerve root is removed.
• Discectomy: A discectomy removes a portion of a disc pressing on a nerve root or the spinal cord.
• Laminectomy: A laminectomy is decompression surgery aimed at relieving pain and functional impairments by relieving pressure on the spinal nerves caused by spinal stenosis. Herniation can lead to symptoms such as pain, numbness, or weakness in the legs, back, and buttocks.
• Artificial disc replacement: The damaged disc(s) is completely removed and replaced with an artificial disc. Artificial disc replacement offers an alternative to fusion surgery for patients younger than age 65 who are suffering from significant chronic neck or lower back pain due to degenerative disc disease. It preserves spinal motion but is only available for patients who have one or two levels of degeneration and who do not have significant facet joint disease, spinal stenosis, or spinal instability. For carefully selected patients, it can significantly reduce pain and disability.

The treatment choice depends on the symptoms’ severity, the herniation’s specific characteristics, and the patient’s overall health and preferences. Conservative treatments are usually tried first, with surgery considered if these measures fail to alleviate symptoms or if neurological deficits progress.