A lumbar disc herniation affects one of the 5 lumbar located in the lower back. It is a potentially painful problem in which the hard outer coating of the discs, which are the circular pieces of connective tissue that cushion the bones of the spine, are damaged, allowing the discs’ jelly-like center to leak, irritating nearby nerves. This causes severe sciatica and nerve pain down the leg. A herniated disc is sometimes called a ruptured disc.
Symptoms:
- Pain in the lower back that worsens with movement, bending, or lifting
- Numbness and tingling in the legs
- Numbness and tingling that radiates from the buttocks to the leg or foot
- Problems with bowel or bladder function
Diagnostic Testing:
X rays: Traditional x rays use low levels of radiation to project a picture onto a piece of film (some newer x rays use electronic imaging techniques). They are often used to view the bones and bony structures in the body.
Magnetic Resonance Imaging (MRI): MRI uses a strong magnetic force instead of radiation to create an image. Unlike an x ray, which shows only bony structures, an MRI scan produces clear pictures of soft tissues, too, such as ligaments, tendons, and blood vessels. An MRI scan, in most instances, is not necessary during the early phases of low back pain unless your doctor identifies certain “red flags” in your history and physical exam. An MRI scan is needed if the pain persists more than 3–6 weeks, or if your doctor feels there may be a need for surgical consultation.
Computed Tomography (CT) scan: A CT scan allows your doctor to see spinal structures that cannot be seen on traditional x-rays. It is a three-dimensional image that a computer creates from a series of two-dimensional pictures that it takes of your back.
EMG: An EMG test allows your doctor to measure the muscles response to nerve stimulation.
Treatment:
- Non-steroidal, anti-inflammatory medication
- Injection of steroids
- Physical therapy
- Surgery
Surgical Treatment options for disc herniation:
Laminectomy/discectomy: In this operation, part of the lamina, a portion of the bone on the back of the vertebrae, is removed, as well as a portion of a ligament. The herniated disc is then removed through the incision, which may extend two or more inches.
Microdiscectomy: As with traditional discectomy, this procedure involves removing a herniated disc or damaged portion of a disc through an incision in the back. The difference is that the incision is much smaller and the doctor uses a magnifying microscope or lenses to locate the disc through the incision. The smaller incision may reduce pain and the disruption of tissues, and it reduces the size of the surgical scar. It appears to take about the same time to recuperate from a microdiscectomy as from a traditional discectomy.
Laser surgery: Technological advances in recent decades have led to the use of lasers for operating on patients with herniated discs accompanied by lower back and leg pain. During this procedure, the surgeon inserts a needle in the disc that delivers a few bursts of laser energy to vaporize the tissue in the disc. This reduces its size and relieves pressure on the nerves. Although many patients return to daily activities within 3 to 5 days after laser surgery, pain relief may not be apparent until several weeks or even months after the surgery.
Disc replacement: When a disc is herniated, one alternative to a discectomy – in which the disc is simply removed – is removing it and replacing it with a synthetic disc. Replacing the damaged one with an artificial one restores disc height and movement between the vertebrae. Artificial discs come in several designs.
