Lumbar Disc Herniation

A herniated disk is a condition that can occur anywhere along the spine, but most often occurs in the lower back. It is sometimes called a bulging, protruding, or ruptured disk. It is one of the most common causes of lower back pain, as well as leg pain or “sciatica.”

Between 60% and 80% of people will experience low back pain at some point their lives. Some of these people will have low back pain and leg pain caused by a herniated disk.

Although a herniated disk can be very painful, most people feel much better with just a few weeks or months of nonsurgical treatment.

RISK FACTORS
Certain factors may increase your risk of a herniated disk. These include:
– Gender. Men between the ages of 20 and 50 are most likely to have a herniated disk.
– Improper lifting. Using your back muscles instead of your legs to lift heavy objects can cause a herniated disk. Twisting while you lift can also make your back vulnerable. Lifting with your legs, not your back, may protect your spine.
– Weight. Being overweight puts added stress on the disks in your lower back.
– Repetitive activities that strain your spine. Many jobs are physically demanding. Some require constant lifting, pulling, bending, or twisting. Using safe lifting and movement techniques can help protect your back.
– Frequent driving. Staying seated for long periods, plus the vibration from the car engine, can put pressure on your spine and disks.
– Sedentary lifestyle. Regular exercise is important in preventing many medical conditions, including a herniated disk.
– Smoking. It is believed that smoking lessens the oxygen supply to the disk and causes more rapid degeneration.

SYMPTOMS
In most cases, low back pain is the first symptom of a herniated disk. This pain may last for a few days, then improve. Other symptoms may include:
– Sciatica. This is a sharp, often shooting pain that extends from the buttock down the back of one leg. It is caused by pressure on the spinal nerve.
– Numbness or a tingling sensation in the leg and/or foot
– Weakness in the leg and/or foot
– Loss of bladder or bowel control. This is extremely rare and may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.

TREATMENT
For the majority of patients, a herniated lumbar disk will slowly improve over a period of several days to weeks. Typically, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery.

Initial treatment for a herniated disk is usually nonsurgical in nature. Treatment focuses on providing pain relief.
Nonsurgical treatment may include:
Rest. One to 2 days of bed rest will usually help relieve back and leg pain. Do not stay off your feet for longer, however. When you resume activity, try to do the following:
– Take rest breaks throughout the day, but avoid sitting for long periods.
– Make all your physical activity slow and controlled, especially bending forward and lifting.
– Change your daily activities to avoid movements that can cause further pain.

Nonsteroidal anti-inflammatory medications (NSAIDs). Medications such as ibuprofen or naproxen can help relieve pain.

Physical therapy. Specific exercises will help strengthen your lower back and abdominal muscles.

Epidural steroid injection. An injection of a cortisone-like drug into the space around the nerve may provide short-term pain relief by reducing inflammation.

There is good evidence that epidural injections can successfully relieve pain in many patients who have not been helped by 6 weeks or more of other nonsurgical care.

Only a small percentage of patients with lumbar disk herniation require surgery. Spine surgery is typically recommended only after a period of nonsurgical treatment has not relieved painful symptoms, or for patients who are experiencing the following symptoms:
– Muscle weakness
– Difficulty walking
– Loss of bladder or bowel control

Microdiskectomy. The most common procedure used to treat a single herniated disk is microdiskectomy. The procedure is done through a small incision at the level of the disk herniation and often involves the use of a microscope.

The herniated part of the disk is removed along with any additional fragments that are putting pressure on the spinal nerve.

A larger procedure may be required if there are disk herniations at more than one level.

Rehabilitation. Your doctor or a physical therapist may recommend a simple walking program (such as 30 minutes each day), along with specific exercises to help restore strength and flexibility to your back and legs.

To reduce the risk of repeat herniation, you may be prohibited from bending, lifting, and twisting for the first few weeks after surgery.

OUTCOMES
Overall, the results of microdiskectomy surgery are generally very good. Patients tend to see more improvement of leg pain than back pain. Most patients are able to resume their normal activities after a period of recovery following surgery. Typically, the first symptom to improve is pain, followed by overall strength of the leg, and then sensation.

In recent years, there has been extensive research on the treatment of disk herniation. Your doctor will be able to talk with you about the advantages and disadvantages of both surgical and nonsurgical treatment.