LUMBAR DISC HERNIATION'S
As a disc degenerates and breaks down, the inner core can leak out through the outer portion of the disc, and this condition is known as a disc herniation or a herniated disc.
The weak spot in the outer core of the inter-vertebral disc is directly under the spinal nerve root, so a herniation in this area puts direct pressure on the nerve.
The nerve runs through the leg, and any type of pinched nerve in the lower spine can cause pain to radiate along the path of the nerve through the buttock and down the leg. This type of pain is also called sciatica or a radiculopathy.
Lumbar Herniated Disc Symptoms
General symptoms typically include one or a combination of the following:
- Leg pain (sciatica), which may occur with or without lower back pain. Typically the leg pain is worse than the lower back pain.
- Numbness, weakness and/or tingling in the leg
- Lower back pain and/or pain in the buttock
- Loss of bladder or bowel control (rare), which may be an indication of a serious medical condition called cauda equina syndrome.
L4-L5 and L5-S1 Disc Herniation Symptoms
The vast majority of disc herniations will occur toward the bottom of the spine at L4- L5 or L5- S1 levels. In addition to typical sciatica symptoms, nerve impingement at these levels can lead to:
- L5 nerve impingement (at the L4 – L5 level) from a herniated disc can cause weakness in extending the big toe and potentially in the ankle (foot drop). Numbness and pain can be felt on top of the foot, and the pain may also radiate into the buttock.
- S1 nerve impingement (at the L5 – S1 level) from a herniated disc may cause loss of the ankle reflex and/or weakness in ankle push off (patients cannot do toe rises). Numbness and pain can radiate down to the sole or outside of the foot.
Lumbar Herniated Disc Treatments
In most cases, if a patient’s pain is going to get better it will start to do so within about six weeks.
While waiting to see if the symptoms will abate on their own, several non-surgical treatments can help alleviate the pain and facilitate long term healing. The most common herniated disc nonsurgical treatments include:
- Physical therapy Main Strength and flexibility
- Mechanical Decompresion (12-20 treatments)
- Osteopathic/chiropractic manipulation (manual manipulation)
- Spinal Decompresion
- Heat and/or ice therapy
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Oral steroids (e.g. prednisone or methyprednisolone)
- An epidural (cortisone) injection
If the pain and other symptoms continue after 12 weeks, and if the pain is severe, it is reasonable to consider microdiscectomy surgery as an option.