Lumbar Disc Herniation

Where is the lumbar spine?

The lumbar spine is located in the lower back and is made up of the 5 lower vertebrae and the sacral spine (4 tiny bones that make up the coccyx (tail bone)). The lumbar vertebrae are numbered L-1 through L-5 and is the most common area for a herniated disc. The experts at BICMD are the “best-in-class” orthopedic spine specialists in the country. They can diagnose lumbar spine conditions through a telemedicine visit and will offer the best treatment advice for your individual back pain, disc herniation or other spinal condition.

What is a lumbar disc herniation?

A lumbar disc herniation is sometimes called a bulging or ruptured disc. It is one of the most common causes of lower back pain. A herniated disc can have hip or flank pain as well as leg pain or “sciatica.” The discs between the vertebrae act as shock absorbers, preventing the bones of the vertebrae from rubbing together. These discs are made up of an inner soft, gel-like layer and an outer, rubbery substance called the annulus. A lumbar disc herniation occurs when the gel-like center of the disc ruptures through the annulus. The gel-like material causes a chemical-type reaction and irritates the nerves of the lower spine. The pressure of the herniated disc on the nerve causes inflammation, resulting in pain.

What is the difference between a herniated disc and a bulging disc?

A bulging disc is slightly different from a herniated disc, but the affects can be similar. A bulging disc occurs when the disc becomes compressed, causing the nucleus (outer ring of the disc) to break down and bulge outward.

A ruptured disc occurs when the ring of the annulus breaks down and tears or ruptures. The nucleus breaks outside of the annulus and causes pressure on the nerve roots located just behind the disc space.

What are the symptoms of a lumbar disc herniation?

The symptoms for a bulging disc, ruptured disc or lumbar disc herniation can include:

• Continuous or intermittent back pain made worse by movement
• Back pain that worsens with sitting or standing for long periods of time
• Back muscle spasms
• Sciatica – Pain that starts in the lumbar spine and radiates to the buttock, then down the affected leg
• Muscle weakness in the leg
• Numbness or tingling in the leg or foot
• Cramping in the back or leg
• Loss of knee or ankle reflex
• Foot-drop (in extreme cases)

Pain that is accompanied by loss of bladder or bowl control, although rare, is an indication of a serious herniation where the spinal nerves are being compressed. This condition requires immediate medical attention.

How is lumbar disc herniation diagnosed?

Our orthopedic spine experts will obtain a patient history as well as x-ray and MRI results. An MRI is one of the best diagnostic tests available for detecting a herniated disc. It will allow the orthopedic specialist to see the disc, spinal cord, nerve roots and surrounding areas.   Two other diagnostic tests may be used which include:

• Myelogram – An injection of contrast fluid is placed into the surrounding cerebrospinal fluid spaces and then x-rayed to determine where the nerve is being compressed.
• Electromyogram and Nerve Conduction Studies (EMG/NCS) – Measures the electrical impulse of the nerve and can determine if nerve damage is present, or if the nerves are in a state of healing.

What is the treatment for a lumbar disc herniation?

Non-surgical treatment:

The initial treatment for a lumbar disc herniation is conservative. Our physicians recommend the following:

• Rest from strenuous activities, especially lifting. Bedrest is not recommended.
• Cold and hot therapy
• Massage therapy
• Physical therapy
• NSAIDs – Non-Steroidal Anti-Inflammatory Drugs
• Muscle relaxants
• Steroids
• Spinal Injections

Surgical treatment:

If non-surgical treatments fail to alleviate lower back pain, or in cases of herniation, such as a foot drop or loss of bowel or bladder control, surgery may be necessary. Surgical treatment of a lumbar disc herniation may include:

• Lumbar Microdiscectomy
• Lumbar Laminectomy
• Lumbar Fusion
• Artificial Disc Surgery