Lumbar Disc Herniation

The main cause is degenerative disc disease. With age, intervertebral discs lose water content and become less flexible and more at risk to tear or rupture with even minor strain. Other causes include injury from an accident such as a fall, or heavy lifting, and in some individuals, genetics play a role. Repetitive strain from an occupation or an activity that involves repeated blending, lifting or twisting can increase the risk of disc rupture. In addition, lifestyle factors such as smoking, lack of regular exercise and poor posture can contribute to disc degeneration and herniation.

Some people can have a herniated disc and minimal to no symptoms, while others will experience low back pain, weakness, and/or numbness. Lumbar disc herniation commonly causes radiculopathy, which is pain that radiates from the back to the buttock, thigh, leg, ankle, or foot depending on the specific nerve involved. Commonly, stressors such as with having a bowel movement, cough, or sneeze can exacerbate nerve pressure and pain by causing the disc to bulge slightly more. Sitting, driving and bending forward can also make the pain worse. Rarely and in the worst case scenario, lumbar disc herniation can cause a loss of bladder and bowel control. This is called cauda equina syndrome and requires immediate medical attention.

Dr. Matthew Colman will review your medical history and inquire about your history of low back and leg pain. He may move the affected limb to check for reflexes, muscle strength, and sensation. This neurological exam may be all that is necessary to diagnose a herniated disc. Imaging tests include X-rays to assess structure of the spine, CT scan for detailed bony imaging of the spine, and MRI to provide detailed images of the soft tissues, including the lumbar discs and nerves. With the results of his clinical exam and these tests, he will make his diagnosis.

Most people with a herniated disc will find relief from their pain within 6 to 12 weeks using common nonsurgical treatments. Reasons to proceed directly to surgery instead of using conservative care include progressive nerve deficits or cauda equina syndrome (loss of bowel and or bladder control).

Conservative or nonsurgical treatments includes rest, activity modification, physical therapy, and a variety of medications including analgesics, anti-inflammatories, muscle relaxers, or nerve-pain medications called neuromodulatories.  Epidural steroid injections may be recommended when oral medications fail to relieve pain and inflammation.  Lifestyle changes (diet and exercise) may be recommended when the patient is overweight. The patient may be advised to avoid heavy lifting and practice good posture, exercise regularly, and stop smoking.

When conservative measures fail to resolve symptoms within 6 to 12 weeks, surgery may be necessary. Surgical treatment for disc herniation is predictable, routine, and generally does not create higher risk of further surgeries down the road. Surgical options include:

• Microdiscectomy: A minimally invasive procedure to remove the damaged portion of the disc, to relieve pressure on the nerves.
• Laminectomy: A surgical procedure that involves more extensive removal of the lamina, a bony structure that forms the roof of the spinal canal. This procedure is performed to relieve pressure on the spinal cord or nerves, often caused by conditions such as spinal stenosis, herniated discs, or other spinal abnormalities.
• Endoscopic Microdiscectomy: A minimally invasive procedure using tiny incisions, cameras, and tools to remove the damaged portion of the disc and relieve pressure on the nerves.

The prognosis for lumbar disc herniation is generally good, with most individuals experiencing significant improvement with conservative treatments. Surgical interventions can provide relief for those who do not respond to non-surgical treatments. Rehabilitation and lifestyle modifications are essential to prevent recurrence and maintain spinal health.