Lumbar Spine Anatomy
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 centre (nucleus pulposus) which is encased in strong elastic tissue that forms a ring around it called annulus fibrosus.
What is Lumbar Disc Herniation?
Lumbar disc herniation is the most common cause of lower back pain and leg pain (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.
Causes of Lumbar Disc Herniation
Obesity, sedentary lifestyle and smoking increase the risk of lumbar disc herniation.
Symptoms of Lumbar Disc Herniation
The symptoms of lumbar disc herniation include:
- Mild-to-intense back pain, making it difficult to bend
- Numbness and weakness in the leg or foot, leading to the sensation of tingling (pins and needles)
- Leg and/or feet pain, making it difficult to walk or stand
In rare cases, loss of bowel and bladder function (cauda equine syndrome), requiring immediate medical attention.
Diagnosis of Lumbar Disc Herniation
The diagnosis of lumbar disc herniation includes medical history coupled with a physical and neurological examination. Neurological examination is performed to indicate any neurological injury and involves the evaluation of reflexes and muscle weakness by various tests. To confirm the diagnosis, your doctor may order an MRI to evaluate changes in the disc and spinal nerves.
Treatment of Lumbar Disc Herniation
Non-surgical Treatment of Lumbar Disc Herniation
Non-surgical treatment is preferred over surgery and includes rest, activity modification, and pain medication, which 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.
Surgery for Lumbar Disc Herniation
Surgery is considered in cases with significant leg pain, muscle weakness, and numbness that is unresolved even after conservative treatment measures. Urgent surgery may be required if neurologic dysfunction or cauda equine syndrome occurs.
Microdiscectomy is the most commonly performed surgical procedure for lumbar disc herniation. It involves the removal of a part of the herniated disc that is causing nerve compression. 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.