Also called a slipped or ruptured disc, a herniated disc is a common condition which can be painful and debilitating.
This condition is the major cause of surgery of the spine among adults and requires immediate treatment for the patient to get relief. Let us look at the various aspects of this condition so that you can get to understand it much better.
What is a Lumbar Herniated Disc?
Lumbar disc herniation is common in adults between the ages of 35 and 50 years, though it is still common in people of all ages. It is more common in males as compared to women.
Greater risk of this condition has been noticed in patients who handle heavy loads frequently and those that work with vibrating tools for hours on end. Genetic predisposition has been a subject of research, though conclusive evidence hasn’t been found yet.
The human spine, or backbone, consists of a set of 26 single, interconnected bones called vertebrae. These vertebrae work together as a unit to make sure you move your back effortlessly. These vertebrae are categorized into cervical, lumbar and thoracic vertebrae.
The vertebrae are cushioned from each other by a cushion-like pad that is called a “disc”. This disc holds your vertebrae in place and works to absorb the shocks that come through the spine day in day out.
Each individual disc is made up of two parts: an outer tough “shell” and an inner gelatinous spongy material. When healthy and working properly, the discs keep your spine flexible, allowing you to move and perform all the chores that require the spine to move (walking, bending, sitting, lifting – you name it!).
Lumbar disc herniation occurs when the disc loses some of the gel. Loss of this gel makes the disc pliable and flatter, a process called disc degeneration. The degeneration starts early in life and shows up on imaging tests during early adulthood. When you place pressure on the spine, the outer ring might crack, tear or bulge. When this phenomenon happens in the lower back (the lumbar region), the slipped disc can push against the spinal nerve root located nearby. This is what causes the pain that shoots down into your buttock and down your leg, causing you sleepless nights.
Lumbar Herniated Disc Symptoms
Symptoms of a herniated lumbar disc vary widely – ranging from moderate pain in the back, buttock and legs to widespread weakness and numbness that require urgent medical attention. In most cases, the pain subsides within 4 – 6 weeks. However, the progression and effect of this pain during this time is excruciating and debilitating. The pain and weakness might prevent you from performing normal daily chores and activities, rendering you immobile as well. Let us look at the common symptoms and how they come about.
This is pain that comes from compression of the sciatic nerve. It forms the major symptom that comes with lumbar disc herniation. This condition comes by as a result of various factors. It might be due to mechanical stimulation of the nerve ends, compression of the spinal nerve root or inflammation of the extruded gel.
Disc herniation leads to compression of the nerve root between adjacent discs. The membrane of the nerve becomes ischemic, which in turn leads to pain that progresses quickly.
The cells in the nucleus get extruded between the space left by the herniated disc. The rupture of the disc exposes the hernia to a bed of vessels in the epidural space. Inflammatory cells that originate from the vessels irritate the spinal nerve root, inducing sciatic pain.
When the disc presses against a nerve, the pain radiates along the areas served by that particular nerve in your back, buttocks and legs. This pain is characteristic in the way it presents itself. Here are some of the manifestations of pain from lumbar disc herniation:
- Leg pain: This is normally worse as compared to the lower back pain that occurs. The pain usually radiates from the point of compression down into the back of your leg. This is called sciatica or radiculopathy.
- Nerve pain: This pain occurs in the leg. You will normally describe it as sharp, searing, electric, piercing or radiating pain.
- Low back pain: This usually occurs variably. It might be present, but not always. This pain might be throbbing or dull, and might come with stiffness of the back.
- Pain that worsens with an action. The pain might worsen with movement or with hunching forward. It might become pronounced following prolonged standing, sitting, or walking. A sneeze, sudden laugh or any other sudden action might intensify the pain. You might also find that hunching or slouching forward or bending at the waist might intensify the leg pain.
- Pain that develops fast: The pain from a lumbar herniated disc comes suddenly and progresses very fast. You might not attribute the pain to a specific cause or action.
- The leg pain is usually accompanied by weakness, numbness or tingling sensations.
Numbness and Tingling
When you have a herniated disc, the spinal nerve becomes “pinched” and might not deliver the required signals to parts of the body it supplies. This means these areas of the body become numb and experience tingling.
The sciatic nerve supplies muscles in the legs. When affected, the nerve won’t deliver the signals to these muscles to work properly, which in turn leads to the muscles becoming weaker. The worst that can happen is for the muscles to fail, leading to foot drop or stumbling when you walk.
The spinal cord separates below the waistline into individual nerves, each having a specific function. If, though rarely, all the nerves in the cord become compressed at the lumbar herniation point, you might experience total paralysis, weakness, sexual dysfunction and loss of bladder and bowel control.
Diagnosis of a Lumbar Herniated Disc
The process of diagnosing herniated discs is systematic. Your first contact with the doctor will start with a physical examination. The doctor will be looking at your reflexes, muscle strength, walking ability, range of motion, tender regions in the back and sensitivity to touch. This will give the doctor the first indication of a herniated spinal disc.
Although a lumbar disc herniation is the first culprit when it comes to sciatica, there are other causes that the doctor must rule out. Some of the causes include infection and tumors. The doctor must rule all these out before deciding on the treatment strategy to use.
After the physical examination, the doctor will want to confirm the diagnosis by using imaging techniques.
The first-choice medical examination method for a herniated lumbar dis is magnetic resonance imaging (MRI). This method is highly sensitive when it comes to identifying this condition. An MRI will provide a lot of details on the bone and soft tissue so that the doctor can correctly assess the extent of the disease and confirm correct diagnosis to start treatment. Using MRI, the doctor will classify the hernia depending on the shape. This might be a protrusion, an extrusion or a sequestration.
Protrusion is where the height of the hernia is less compared to the base. Extrusion is whereby the base length is less compared to the height. Sequestration, just the way the name implies, is when no continuity exists between the gel and the disc.
Computerized Tomography (CT) Scan
The use of this method gives the doctor a series of images that create a cross-section of the spine and the tissues that surround it. CT scans are detailed as well and will help pinpoint the problem and give the doctor an idea of the extent of the herniation.
Advances in technology have led to the possibility of developing 3-dimenional images from the CT scans. These scans can help rule out the occurrence of spinal tumors as well, which makes the diagnosis of a herniated disc justified.
A regular X-ray of the spine usually gives only a picture of the bones. In discography, the imaging expert injects contrast dye into the spongy center of one or more discs, which makes the center of these discs visible on X-rays. This method works in two ways – viewing the integrity of the disc and finding the exact source of your low back pain.
This method is ideal for evaluating a painful or degenerative lumbar disc. The contrast dye that gets injected in the disc will show whether the disc ring has cracks or is ruptured. The results of this procedure might confirm the need for surgery or not. It also pinpoints the location of the pain, which will increase the positive outcome of your surgery.
Treatment Options for Lumbar Herniated Discs
You might want to treat the symptoms of a herniated lumbar disc or decide to repair the disc. Repairing involves surgical procedures that seek to treat the root cause and prevent recurrence. Let us look at these two approaches: conservative treatment and surgical approaches.
The nature of herniated discs is benign in nature. The aim of conservative treatment is to reduce the incidence of pain and stimulate your nerves to heal. Another objective is to help you return to work and normal daily living faster. Conservative treatment is indicated for young patients whose hernias are small with less disc degeneration.
Conservative treatment should use non-steroidal anti-inflammatory drugs (NSAIDs) most, because they target the inflammation and reduce pain. You can use analgesics for therapeutic reasons.
You can opt for corticoids and anaesthetics so as to block the affected nerve root. These drugs work directly on the hernia and reduce the inflammation, thereby reducing the volume of the hernia as well.
You also have the option of using analgesia to reduce pain support physiotherapy to relax. Some of the strategies towards this include stretching exercises.
Another appealing treatment that has shown effective results is spinal decompression. The treatment seeks to alleviate the chronic pain caused by disc herniation. The procedure can be mistaken for a typical traction, but the process involves accumulating a certain level of negative pressure that draws the extruded materials back into the centre of the spine. This procedure is ideal for handling sciatica.
CBD oil has become one of the latest innovative ways to prevent the degeneration of intervertebral discs. The oil works by reducing damage to the disc, which in turn reduces the pain and further herniation. The psychoactive nature of this oil makes it the best for topical application.
The aim of surgical procedures is to reduce pressure on compressed nerves. However, the doctor needs to positively identify the indications of surgery before going ahead with it. Here are the indications.
If you are suffering from sciatica that doesn’t respond to treatment for at least 6 weeks, and you have a motor deficit that is greater than grade 3, or you are experiencing nerve root pain that accompanies bone stenosis, then you need urgent surgery.
Significant paresis is also an absolute indication for surgery. Cauda equine syndrome is also a direct indication.
The term surgery is scary to most people, but it shouldn’t scare you. Due to the advancements in medical technology, lumbar herniated surgery is quite non-invasive with a short recovery period. The surgery can take as short as an afternoon or a one day in hospital. The average recovery period varies from one person to another, but expect to be back to work in one month, or less.
Another surgical procedure that represents one of the last options is artificial disc replacement, which is indicated for intervertebral disc degeneration. The process seeks to replace a damaged disc which is generating chronic back pain.
If you suspect a herniated lumbar disc, your first reaction should be a visit to the nearby doctor. The doctor performs a physical examination followed by various imaging tests to detect the exact source of pain. After all these tests, the doctor decides the correct course of action, which can be conservative treatment to mitigate the symptoms, or a surgical approach to repair any defect in the lumbar disc.