LUMBAR DISC HERNIATION
While a herniated disc (commonly referred to as a “slipped disc”) can happen anywhere along the spine, most cases occur in the lumbar (lower back) section. It is sometimes referred to as a bulging, protruding, or ruptured disc, and it’s one of the most common causes of lower back pain, as well as pain that radiates down the back of the legs (known as sciatica).
“I would highly recommend the Southwest Scoliosis and Spine Institute. I was barely able to walk because of sciatic nerve pain in my right leg due to a massive herniated disc in my lower lumbar. My doctor explained my options and he was confident surgery would relieve the pain and he was absolutely right! When I woke up from surgery, I felt no pain in my right leg. I’m recovering just fine! The whole office listens and doesn’t make you feel like he’s in a hurry. The staff is excellent. I’ve called with numerous questions and his staff calls back the same day with answers.” – Becca
Southwest Scoliosis and Spine Institute’s board-certified, fellowship-trained orthopedic doctors, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Y. Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have years of experience treating thousands of patients with complex spine conditions, including herniated lumbar discs.
A herniated lumbar disc normally happens due to aging or normal wear and tear. The outer layer of tissue holding the disc in place can gradually degrade over time (a condition known as degenerative disc disease). Also, a herniated lumbar disc may also be the result of a traumatic injury, but this is less common.
A normal middle of the disc is called the nucleus pulposus. Inside the disc is a soft part surrounded by a tougher outer shell, like a tire. Inside the disc, it is composed of a jelly-like material that consists of mainly water, and a network of collagen fibers. In the normal disk, the nucleus pulposus moves anteriorly with your lumbar spine as it extends. A herniated disc loses the soft middle and no longer provides the cushion between vertebras.
Symptoms of a herniated lumbar disc include:
- Lower back pain
- Leg pain
- Weakness or numbness
- Difficulty lifting the feet when walking or standing called foot drop
- Painful tingling or feelings like electric shocks, usually in the buttocks and legs
Usually, the first (and by far the most common) symptom of a herniated lumbar disc is located in the lumbar spine. This part of the spine is located in the lower back area. This condition also normally presents with pain in the lower back. When a lumbar disc herniation presses on the nerves, it can lead to a condition known as sciatica. The discs in your back are like shock absorbers. When these shock absorbers lose the fluid inside, the bones start to rub together. Sometimes it may pinch the closest nerve and cause pain. Hence, it will cause pain and possibly numbness, tingling, or weakness in the buttocks and down the back of the legs.
When a herniated disc presses on nearby nerves, it can cause pain, numbness, and weakness where the nerve(s) travels. If it isn’t pressing on a nerve, you may only experience minor pain or even no pain at all.
In severe cases, this condition can lead to a loss of bladder or bowel control. While this is rare, it can be an indication of a serious condition requiring immediate medical attention.
Diagnosing a Herniated Disc
When you come to Southwest Scoliosis and Spine Institute, your doctor will start by going over your medical history and performing a thorough physical exam, looking for any difficulty walking or pain in the lower back. Furthermore, they may ask you to do a leg raise test to see if you are experiencing ‘foot drop’ or other neurological symptoms.
The doctor will confirm a diagnosis of lumbar disc herniation using X-ray imaging, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI). Because X-ray imaging can only show issues with the bones themselves and not the soft tissue, a CT or MRI scan may be necessary to confirm the condition.
When diagnosing the cause of discomfort or pain in the lower back, one of the causes could be lumbar spinal stenosis.
Our practice uses an advanced low-dose radiation X-ray imaging system that takes high-quality images of patients in under a minute. In addition, it can also take X-rays of patients in multiple positions, and it’s conveniently located inside our Dallas location, which means that you and your doctor can review the X-rays right after they are taken, during your appointment.
When a herniated disc presses on nearby nerves, it can cause pain, numbness, and weakness in the area of the body where the nerve(s) travels. If it isn’t pressing on a nerve, you may only experience minor pain or even no pain at all.
In severe cases, this condition can lead to a loss of bladder or bowel control. While this is rare, it can be an indication of a serious condition that requires immediate medical advice.
Treatment for Lumbar Disc Herniation
Fortunately, most patients do not require surgery for a herniated lumbar disc. Similarly, they will improve with nonsurgical treatment over a period of days or weeks. In most cases, patients fully recover within 2-4 months, though the pain may return on and off while they recover.
At the Southwest Scoliosis and Spine Institute, our physicians always try to take a conservative approach to treatment before considering surgery. Above all, the doctor will consider all options, and treatment will depend largely on the patient’s age, health, and condition.
Moreover, non-surgical treatments for lumbar disc herniation include:
- Staying active. The best way to help reduce swelling and ease the pain is just to do low-intensity activities like walking. Staying off your feet for a few days is usually advised, but most doctors do not recommend bed rest for more than 1-2 days. It’s also important to avoid sitting for long periods of time.
- Physical therapy. Your doctor may recommend that you see a physical therapist. However, your doctor may recommend exercises to help strengthen and stabilize the muscles of the lower back and abdomen.
- Non-steroidal medications. Over-the-counter medications that help reduce swelling and pain. Your doctor may also prescribe extra-strength versions for a short period of time.
- Epidural steroid injection. Injections of steroidal drugs near affected nerves can help by providing short-term pain relief and further reducing inflammation.
Surgery for Herniated Lumbar Disc
Only a small percentage (about 10-15%) of patients with lumbar disc herniation require surgery. Herniated disc surgery is typically recommended if nonsurgical treatment has not relieved painful symptoms.
Surgical treatment includes:
- Lumbar discectomy. This procedure involves removing any affected disc(s) through an incision in the back. This surgery is often the best option when there is more than one herniated disc on different levels of the spine.
- Microdiscectomy. Typically used when there is just a single herniated disc, a microdiscectomy is a minimally invasive version of a discectomy. Using a much smaller incision, the surgeon performs the operation with the use of a thin tube with a microscopic camera on the end. Like the regular discectomy, any herniated portion of the disc is removed.
- Lumbar laminectomy. This procedure commonly accompanies a discectomy/microdiscectomy, as it gives the surgeon access to the herniated disc. During a laminectomy, a small opening is made in the lamina, which is the back part of the vertebra that covers the spinal canal.
After the disc is removed through a discectomy, the spine may need to be stabilized via a spinal fusion procedure. The doctor uses bone grafts, screws, rods, etc. to hold the vertebrae in place while they heal.
“At Southwest Scoliosis and Spine Institute, we treat disc herniations based on symptoms. The initial treatments are physical therapy and medications. The next set of treatments would be pain management injections. Ultimately, some people will require surgery to relieve the damaged disc and alleviate the nerve pain.” – Richard Hostin, MD
If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment.