Lumbar disc herniation, diagnosis and treatments

The human spine or vertebral column consist of 24 vertebrae the sacrum and the coccyx. Out of these 24 vertebrae, 7 are cervical, 12 thoracic and 5 are lumbar, based on the region and position they occupy in the body. Each vertebra is separated by an intervertebral disc that allows vertebrae movement and hold the spine together.  The spinal discs are soft cushions that separate each vertebra and work as ligaments to hold the spine together and give movement between vertebrae.

The spinal discs are made of a soft central nucleus surrounded by a tougher fibrous ring. A spinal disc herniation occur when damage in the tougher fibrous ring lets a portion of the nucleus to bulge out beyond this ring releasing inflammatory chemical mediators and generating pressure on nerve roots resulting in severe and chronic pain.  This damage or rupture in the tougher fibrous ring can be the result of trauma, lifting injuries, aging disc degeneration, and incorrect sitting postures.

Most of the spinal disc herniations take place in the lower back, typically between the L4-L5 lumbar vertebrae or between the L5-S1. Around 95% of the spinal disc herniation cases occur in the lumbar region, causing pain and symptoms that can affect the lower back region buttocks and legs.

Symptoms of a lumbar disc herniation include:

  • Chronic and intense pain that can extend from the lower back to the buttocks, thighs, genital region, back of the leg and on to the foot area
  • Muscular weakness, numbness or tingling of the buttocks thigh or leg muscles
  • Sciatica, which is the name given to the leg and low back pain caused by the irritation and pressure that an herniated disc can place on the sciatic nerve
  • Muscle spasms and pulsating pain
  • Burning sensation and difficulty controlling the legs
  • Diagnosis

    Usually a medical practitioner will be able to easily identify a lumbar disc herniation based on the symptoms, medical history and a simple physical exam of the patient. Additional examinations and tests may be performed to discard more serious conditions like tumors, infections or fractures. Electromyograms may also be implemented to determine the severity and location of any nerve damage caused by this condition.

    Treatment

    Treatment of a herniated lumbar disc begins with a period of approximately six weeks on which the patient will be treated with non-surgical methods to relieve pain and determine if the disc is going to heal by its self, without the requirement of surgical intervention. Most minor disc herniations heal in a few weeks; some non-surgical treatments for pain associated with a lumbar disc herniation are:

    • Pain Relievers: Initially, pain relievers like tramadol are frequently prescribed to  help the patient deal with severe and chronic pain symptoms
    • Physical therapy: Electrical stimulation, massages, core strengthening exercises, traction and many other therapies in combination with pain relievers can promote a complete healing of the herniated disc
    • Oral Steroids
    • An epidural (cortisone) injection

    *Chiropractic manipulations are contraindicated as there are nerves that could be dangerously damaged by the pressure generated by the herniated disc, also there is no evidence for its usefulness reducing chronic pain or promoting healing.

    Surgical intervention may be required in severe cases on which the disc does not heal after a period of 4 months or the nerves are severely affected. There are many surgical options but most of them focus on relieving nerve compression, allowing the nerve to recover and restoration of normal function.

    Surgical Options:

    • Microdiscectomy
    • Chemonucleolysis
    • Lumbar fusion
    • Dynamic stabilization
    • Artificial disc replacement

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