Lumbar disc herniation is the most common cause of low back pain and leg pain (sciatica). The lumbar intervertebral discs are flat and round, present between the lumbar vertebrae and act as shock absorbers when you walk or run. There is a soft, gelatinous material in the center (nucleus pulposus) which is encased in strong elastic tissue forming a ring around it called annulus fibrosus.
Ageing, injury or trauma may cause the annulus fibrosus to tear resulting in protrusion of the nucleus pulposus. This may compress the spinal nerves and/or spinal canal. The bulging disc may even break open releasing the gelatinous material, which is a chemical irritant, causing inflammation of the spinal nerves.
Obesity, sedentary lifestyle and smoking increase the risk of lumbar disc herniation.
The symptoms of lumbar disc herniation include:
- Mild to intense back pain, making it difficult to bend
- Numbness and weakness in the leg or foot leading to the sensation of tingling (pins and needles)
- Leg and/or feet pain making it difficult to walk or stand
- In rare cases, loss of bowel and bladder function (cauda equine syndrome) may occur. This condition requires immediate medical attention.
Diagnosis includes medical history coupled with physical and neurological examination. Neurological examination is done to indicate any neurological injury and involves evaluation of reflexes and muscle weakness by various tests. To confirm the diagnosis the doctor may order a MRI to evaluate changes in the disc and spinal nerves.
Non-surgical treatment is preferred over surgery and includes rest, activity modification, and pain medication which includes non-steroidal anti-inflammatory drugs, muscle relaxants and epidural analgesic injections. Back braces are recommended for a few days to keep the lower back still and reduce mechanical pain due to movement. Physical therapy or acupuncture may be helpful in some cases.
Surgery is considered in cases with significant leg pain, muscle weakness and numbness that is unresolved after conservative treatment measures. Urgent surgery may be required if neurologic dysfunction or cauda equine syndrome occurs.
Microdiscetomy is the most commonly used surgical procedure for lumbar disc herniation. It involves removal of part of the herniated disc causing nerve compression. It is a comparatively safe procedure but some of the risks include infection, nerve damage, dural leak, or hematoma. Most patients undergoing surgery find significant respite in pain after the surgery.
Talk to your surgeon about any concerns you have about surgery.