A lumbar herniated disc is a painful health condition occurring in the lower back when the gel-like center of a disc in the lumbar section of the spine ruptures through a weak area in the outer disc wall. The nerve roots then exit the spinal canal through the small space between the vertebrae and discs. When the damaged disc pushes into these nerve roots or the spinal canal, individuals suffer pain and other symptoms.
A majority of herniated discs occur between the fourth and fifth lumbar segments of the spine or between the fifth lumbar segment and the first sacral segment. In the latter case, the weak spot in the outer core of the disc is directly underneath the spinal nerve root, and the herniated disc puts direct pressure on the nerve. This causes sciatica, which is a sharp, severe pain that radiates all the way down the leg and into the foot. A lumbar herniated disc might also affect the femoral nerve, which can cause numbness, tingling, or burning in the legs, feet and hips. Pain might also be felt in the lower back and buttocks.
A lumbar herniated disc can also cause a feeling similar to an electric shock when an individual stands, walks or sits. Bending and lifting can intensify the back pain. Unlike the pulsating pain caused by muscle spasms, the pain from a lumbar herniated disc is usually continuous. Individuals might also experience muscle weakness in the legs and ankle or knee reflex loss. In extreme cases, people can experience a loss of bowel or bladder control.
Although this condition can be quite painful, a majority of herniated lumbar discs will heal themselves in about six weeks. While waiting to see if a disc heals on its own, several nonsurgical options can help reduce the pain and discomfort. Some of the most common nonsurgical treatments include non-steroidal anti-inflammatory drugs (NSAIDs), oral steroids and cortisone injections. Many patients report feeling relief if they combine these medications with physical therapy, chiropractic manipulations, hydrotherapy, graduated exercise programs, yoga therapy or massage therapy
If the pain continues after six weeks, however, microsurgical discectomy is an option. A microdiscectomy takes the pressure off the nerve root by removing the small portion of the disc that is pressing on it. Requiring just a small incision in the middle of the back, this surgery is typically performed on an outpatient basis and most patients return to work in a couple of weeks. Other surgical options include a lumbar fusion and an artificial disc replacement. The goals for all of these surgical options include the relief of pain and nerve compression.
Lumbar herniated discs can be caused from general wear and tear, such as jobs that require constant sitting or a lot of heavy lifting. Traumatic injury to lumbar discs can happen when an individual is lifting while bent at the waist, rather than lifting with the legs. A lumbar disc can also rupture when it receives too much pressure at once. For example, falling off a ladder and landing in a sitting position puts a great deal of force on the spine and can cause lumbar discs to rupture.
Lumbar discs also tend to harden and dry out as people age. This can weaken the outer disc wall to the point where it can no longer contain the disc nucleus. A majority of lumbar herniated discs occur to individuals in their thirties and forties. Smoking, genetics and a lifetime of rough and tumble sports can lead to early lumbar disc degeneration.
Physicians diagnose a lumbar herniated disc using numerous methods. X-rays are commonly used to rule out other possible causes of the pain, such as fractures, infections or tumors. If a physician still suspects a lumbar herniated disc, other diagnostic methods are used to provide a final diagnosis. The most common diagnostic method is a magnetic resonance imaging (MRI) test, which shows the spinal cord, nerve roots and surrounding tissues. A computed tomography scan (CAT or CT scan) can also be used to see the size and shape of the spinal canal, its contents and the soft tissues surround it.