Lumbar discs are the cushions between the vertebrae in the back. Herniation of the disc occurs when the gelatinous inner disc material, the nucleus pulpous, ruptures or herniates, through the outer lumbar disc wall.
Lumbar Herniated Disc Causes
Of the known causes of lumbar disc herniation, the genetic cause seems to be the most important. Twin studies have shown that genetically identical individuals have nearly identical appearing spines (including herniations). The immediate precipitating cause of lumbar herniation can be varied. This can be excessive stress being placed on the disc, whether as a result of heavy lifting or other damaging motions. Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots.
Lumbar Herniated Disc Symptoms
As a disc herniates, it can compress a spinal nerve root. This causes buttock, leg, and foot pain or numbness often referred to as sciatica. The symptoms are usually worse with sitting than most other positions as sitting typically causes more tension on the lower spinal nerve roots. There can be back pain, but when a nerve root is compressed, the vast majority of the pain is in the leg rather than the back.
In some individuals, there are no symptoms at all with disc herniation. Often milder radiating leg pain or weakness will resolve on its own.
Who is a typical lumbar herniated disk patient?
Lumbar disc herniation is usually seen in 20- to 50-year-old individuals; however, all age groups can be affected.
Diagnosing a Lumbar Herniated Disc
Evaluation of a lumbar herniated disk starts with a history and physical. A good history and physical exam will usually make the diagnosis, and nonsurgical treatment can be started. When symptoms do not resolve with initial management, further images are necessary. Generally, the MRI scan is the gold standard for disc evaluation. High-quality scans may visualize not only the disc fragments but also enable the trained observer to follow the entire path of the nerve root as it exits the spine. A plain X-ray is usually obtained as a baseline to look at general anatomy as well as evaluate any bone lesions as part of the preoperative preparation.
Occasionally, a CT myelogram may be done to evaluate the spinal sac, especially if the individual cannot undergo a magnetic scan due to a pacemaker or the like. Sometimes, the injectable dye may be used in conjunction with an MRI to evaluate scar tissue around a nerve root.
Nonsurgical Treatment of Lumbar Disc Herniation
Interventional treatments for a lumbar herniated disc may include:
- Physical therapy and/or exercises can help relieve the symptoms
- Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain and analgesics to relieve pain
- Epidural steroid injections and nerve root injections to help reduce swelling and treat acute pain that radiates to the hips or down the leg
Surgical Treatment of Lumbar Disc Herniation
Some of the surgical procedures used to treat lumbar disc herniation at Emory are: