Lumbar disc herniation
As a disc degenerates and deteriorates, the inner core can leak to the outside of the disc, and this condition is known as herniated disc or herniated disc .
The weak point in the outer nucleus of the intervertebral disc is directly below the spinal nerve root, so a hernia in this area exerts direct pressure on the nerve.
The nerve runs through the leg, and any type of nerve pinched in the lumbar spine can cause the pain to radiate along the nerve path to the buttocks and leg. This type of pain is also called sciatica or radiculopathy.
Symptoms of lumbar disc herniation
The general symptoms generally include one or a combination of the following:
Leg pain , which can occur with or without back pain. Normally, pain in the leg is worse than low back pain.
Numbness, weakness or tingling in the leg.
Lumbar pain or back pain in the buttocks.
Loss of bowel or bladder control , which may be an indication of a serious medical condition called horsetail
syndrome.
Symptoms of herniated disc at levels L4-L5 and L5-S1
The vast majority of herniated discs will occur in the lower part of the spine at levels L4-L5 or L5-S1. In addition to the characteristic symptoms of sciatica, the nerves pinched at these levels can cause:
Impingement of nerve L5 (at level L4 - L5 ) due to a herniated disc, which can cause weakness in the extension of the big toe and, possibly, in the ankle .
Numbness and pain may be felt in the upper part of the foot, and pain may also radiate to the buttock.
Nerve clamping S1 (at level L5 - S1 ) due to a herniated disc, can cause loss of ankle reflex or weakness when pushing the
ankle (patients can not raise the toes). Numbness and pain can radiate to the floor or the outside of the foot.
Treatments for lumbar disc herniation
In most cases, if a patient's pain will improve, they will begin to do so within approximately six weeks.
While waiting to see if the symptoms are reduced by themselves, several non-surgical treatments can help relieve pain and
facilitate long-term healing. Among the non-surgical treatments for herniated disc are:
Physiotherapy
Osteopathic / chiropractic manipulation
Therapy with heat or ice
Non-steroidal anti-inflammatory drugs
Oral steroids
An epidural injection
If the pain and other symptoms continue after six weeks, and if the pain is severe, it is reasonable to consider a
microdiscectomy surgery as an option.
The microdiscectomy aims to relieve pressure on the nerve root and provide a better healing environment for the nerve. In
general, only the small portion of the disc, which pushes against the root of the nerve, must be removed, and most of the
intervertebral disc remains intact.
Through the use of microsurgery techniques and a small incision, a microdiscectomy can usually be performed on an outpatient
basis or with one night in the hospital. Most patients can return to full work in one to three weeks.
With an experienced surgeon, the success rate of this surgery should be approximately 95%.
Recurrent disc herniation
Unfortunately, approximately 10% of patients will have another disc herniation in the same place. It is more likely that this
recurrence occurs early in the postoperative period , although it may happen years later. In general, recurrence can be treated with another microdiscectomy.
If this happens several times, lumbar arthrodesis surgery may be considered to stop movement at the disc level and remove all disc material.
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