The vertebral column, also called the backbone, is made up of 33 vertebrae that are separated by spongy disks and classified into four distinct areas. The cervical area consists of seven bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of five bony segments in the lower back area; five sacral bones (fused into one bone, the sacrum); and four coccygeal bones (fused into one bone, the coccyx).
Lumbar disc disease occurs in the lumbar area of the spine. The lumbar area of the spine (and other areas of the spine) is made up of two parts, including the following:
The vertebral bodies are numbered from 1 to 5 in the lumbar spine and the discs are located between two of the vertebral bodies and are numbered accordingly (such as a disc at L2-3, or between the lumbar discs numbered 2 and 3).
The intervertebral disc is composed of two parts, including the following:
Low back pain will affect almost 80 percent of Americans at some point throughout their life. Many patients can treat their pain without seeking medical attention through over-the-counter therapies like anti-inflammatory medications, heating pads and rest. However, there are low back pain sufferers that can be ailing from a condition known as a lumbar herniated nucleus pulposus, or herniated disc as it is more commonly referred.
A herniated disc occurs when the disc material breaks the disc annulus and impedes on a nerve root, essentially “pinching” the nerve. This can be a very symptomatic injury and patients with HNP usually present with leg and back pain often accompanied with numbness and/or weakness in the area. Another common symptom of herniated disc is parasthesia or tingling down the legs, usually concentrated to one side.
Not all back pain requires medical attention. In fact, a pulled muscle in the low back area can mimic many neurosurgical defects. If a patient’s herniated disc symptoms do not subside within 2-3 weeks and/or are not improved with anti-inflammatory medications, it could be time to seek a specialist as a more complex problem might exist. Furthermore, if a patient presents with bowel/bladder changes and/or foot drop, immediate attention should be sought as the nerve impingement from the herniated disc is severe.
The most commonly used procedure for the diagnosis of a herniated disc is Magnetic Resonance (MR) Imaging. The sagittal and axial images provide a concise picture of the nucleus pulposus and its placement in relation to the annulus of the disc to determine whether or not herniation has occurred.
There are many successful conservative herniated disc treatment options, two of the most common being physical therapy and epidural steroid injections. Although both are simply potential pain relievers and do not repair the disc, they can improve and possibly resolve the patient’s symptoms. Other non-surgical herniated disc treatment options include muscle relaxants, oral steroids, traction, chiropractic manipulation and acupuncture. The method of treatment for a herniated disc is due in large part to the severity of a patient’s symptoms, what outcome the patient expects and what avenues they are willing to explore.
If and when a patient chooses the surgical treatment of herniated disc, the most common procedure for HNP repair is a Microdiscectomy, which can be performed either traditionally open or minimally invasively. Although the recovery from the surgery is comparable in both approaches, the minimally invasive method tends to have more cosmetic scarring and preserves the paraspinous muscle. Regardless of approach, the Microdiscectomy is done under general anesthesia, and is approximately a one hour surgery to remove the portion of disc that is herniated and release the impinged nerve.
Recovery is minimal and most patients are back to work within two weeks, although all patients should adhere to strict weight restrictions following the procedure to allow the area to heal properly. Most often, patients report immediate relief although some residual parasthesia may present as the nerve regains its posture and function following surgery.
A herniated disc can be a painful intrusion to the daily routine for many people and although many conservative treatments are available, surgical intervention is sometimes the most effective approach to relieve a patient’s symptoms and return the patient to a higher quality of life.
As we age, the intervertebral disc may lose water and become dried out. As this happens, the disc compresses. This may lead to the deterioration of the tough outer ring allowing the nucleus, or the inside of the ring, to bulge out. This is considered a bulging disc.
As degenerative disc continues, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is considered a ruptured, or herniated, disc. The fragments of disc material can then press on the nerve roots that are located just behind the disc space. This can cause pain, weakness, numbness, or changes in sensation.
Most disc herniations happen at the lower lumbar spine, especially at the L4-5 and L5-S1 levels.
Lumbar disc disease is due to a change in the structure of the normal disc. Most of the time, disc disease comes as a result of aging and the degeneration that occurs within the disc. Occasionally, severe trauma can cause a normal disc to herniate. Trauma may also cause an already herniated disc to worsen.
The symptoms of lumbar disc disease vary depending on where the disc has herniated, and what nerve root it is pushing on. The following are the most common symptoms of lumbar disc disease. However, each individual may experience different symptoms. Symptoms may include:
The symptoms of lumbar disc disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for lumbar disc disease may include the following:
Specific treatment for lumbar disc disease will be determined by your physician based on:
Typically, conservative therapy is the first line of treatment to manage lumbar disc disease. This may include a combination of the following:
When these conservative measures fail, surgery for removal of a herniated disc may be recommended. Surgery is done under general anesthesia. An incision is placed in the lower back over the area where the disc is herniated. Some bone from the back of the spine may be removed to gain access to the area where the disc is located. Typically, the herniated part of the disc and any extra loose pieces of disc are removed from the disc space.
After surgery, restrictions may be placed on the patient's activities for several weeks while healing is taking place to prevent another disc herniation from occurring. Your physician will discuss any restrictions with you.
There are other experimental therapies that are being used to treat lumbar disc disease. Discuss these treatment options with your physician.
Copyright © 2013 Beaumont Health System. All Rights Reserved.