The lower part of the spine (lumbar spine) is made up of five vertebrae, each separated by an intervertebral disc which acts as a shock absorber for the spine. The normal intervertebral disc is composed of a nucleus pulposus, at the center, surrounded by a fibrous ring known as annulus fibrosis. Lumbar disc herniation is a condition in which the inner gelatinous substance of the disc escapes through a tear in the outer fibrous ring causing a compression of the spinal cord or the surrounding nerves, resulting in back pain. Lumbar disc herniation is also known as slipped or ruptured disk. It is one of the most common causes of low back pain, as well as leg pain.
Traumatic injury, aging, repetitive movements, wear and tear, smoking, poor diet, and being overweight may affect the structure and functioning of the disc.
The most frequent symptom of a lumbar disc herniation is back pain that radiates to the buttocks and legs. The pain can be mild or severe and is usually aggravated by movement. Other symptoms such as difficulty in moving your lower back, numbness, tingling sensation, muscle weakness, and rarely bladder or bowel problems may also occur.
Precise diagnosis of lumbar disc herniation is important to devise an effective and successful treatment plan. The diagnosis of a lumbar disc herniation is based on your symptoms, medical history, along with a physical and neurological examination. Your sensations, reflexes, and muscle strength will be evaluated by your doctor. Imaging tests such as X-rays, MRI or CT scan may be recommended to confirm the diagnosis of a herniated disc. Simple X-rays will help locate the collapsed disc space. A CT or MRI scan provides detailed images of the discs, nerve roots, and other structures of the spine.
Treatment of a lumbar herniated disc comprises of conservative and surgical treatment options. Non-surgical treatment of lower disc herniation usually helps relieve pain and the associated symptoms. Some of the common nonsurgical measures include activity modifications, anti-inflammatory and pain medications, muscle relaxants, spinal injections, braces, physical therapy, and acupuncture. To increase the likelihood of a successful treatment outcome, you doctor may advise a combination of two or more treatment modalities.
Surgery is not always indicated for patients with lumbar disc herniation. Your doctor may recommend surgery if the lumbar disc herniation is associated with spinal instability or neurological dysfunction or in cases of persistent pain that fail to respond to conservative treatment.
Usually a minimally invasive surgical approach is used to remove the protruding portion of the disc. A lumbar interbody fusion, which can be performed from the front, back or side of the spine, is the most common surgical procedure for the management of lumbar disc herniation. Spinal stabilization and fusion may be performed to alleviate the pain and stabilize the spine.
Your surgeon will discuss the different techniques available for the management of lumbar disc herniation, along with the pros and cons of each technique and will recommend the most appropriate procedure for you.