Lumbar Herniated Disc

۶ دقیقه
Dr Turaj Yazdi / Spinal Cord / Lumbar Herniated Disc

Lumbar Herniated Disc

Table Of Content

Everyone might think of “the spine” as one solid-but-flexible piece but actually it is a combination of small, moving parts that all have to work in concert for proper mobility. Sometimes, though, that harmony has a few players who are way out of tune—namely your discs, the cushion-like pads between your vertebrae. When they become damaged and encroach on nerve roots branching off the spinal cord, that’s when they can strike the wrong note — maybe even a painful one. In other words Lumbar disc herniation is a condition in which the jelly-like nucleus of an intervertebral disc pushes against the tough outer ring called the annulus fibrosus. The pressure on the spinal cord and nearby nerve roots results in lower back pain and other symptoms. The disc material can also release chemical irritants, causing inflammation in the surrounding spinal nerves.

Also slipped discs or ruptured discs is a relatively common condition that can occur anywhere along the spine, but is most likely to affect the lower back or neck.

The lumbar discs are integral in the spinal cord, as they provide cushioning to protect the bony joints in your spine. The discs absorb the shocks during movement while allowing your lumbar spine to support movement and bear your body weight. When an intervertebral disc is damaged, you suffer pain, discomfort and other symptoms that affect your quality of life.

Lumbar Disc Herniation Causes

Physical changes in the structure of a shock-absorbing lumbar spine disc can cause herniation. The lumbar spine supports and stabilizes your body movement. Such changes typically occur for one of three reasons:

  1. Age-related wear and tear
  2. A severe injury to your lower back
  3. Degenerative disc disease

Symptoms of a Herniated Disc

More than 80 percent of the population experience back pain at some point, which may be due to a herniated disc in the lumbar spine. If the herniation is minimal, or it’s not pressing on a nerve, you might have no symptoms at all. For those who have herniations that do affect nerves, pain can be severe and unrelenting. It’s typically felt on one side of the body and may radiate to an arm (if the herniated disc is in the neck) or leg (if a lumbar disc is herniated; sciatica is an example).

  • A dull ache on one side of the body
  • Pain when you cough, sneeze, or move into certain positions
  • Numbness, tingling, or burning sensations, usually from a compressed nerve.
  • Pain that’s worse with sitting, but can standing, walking, and bending can worsen the symptoms as well
  • Muscle weakness or spasm that may affect your ability to lift or hold items
  • Balance issues or limping due to weakness and/or pain
  • Slow reflexes
  • Difficulty getting up from a seated position
  • Inability to remain in one position for an extended period of time
  • Poor posture
  • Loss of bowel or bladder control (which can indicate cauda Equina Syndrome, a medical emergency)

Herniated Discs Diagnoses

If you have a herniated disc, you can see an orthopedist or your primary care doctor to figure out. Your doctor asks you to lye down, and lift one leg straight up. If you have a herniated disc compressing on a nerve, that movement will increase the compression and cause pain throughout that leg. Your doctor will also ask about numbness, weakness, and slow reflexes. Then imaging studies are usually ordered include:

  • Magnetic resonance imaging (MRI)
  • Nerve conduction studies (NCS) and electromyogram (EMG)
  • X-Rays

Treatment Options

Often, there won’t be one single strategy to address herniation in a non-surgical way. You’ll be encouraged to adopt some healthy lifestyle practices along with targeted treatment like physical therapy.

Most people who have herniated discs respond well to conservative treatment and do not require surgery.

In addition to physical therapy and pain-relieving medications as recommended by your doctor, these are a few things you can do to feel better.

  • Get to a healthy weight. Excess weight can worsen compression in the spine, so dropping some pounds may alleviate pain.
  • Quit smoking. In addition to contributing to chronic disease, smoking is a major risk factor for degenerative disc disease, particularly in the lower back and neck.
  • Do low-impact activity. Bed rest may be tempting, but it can lead to more muscle stiffness and weakness.
  • Do core exercises. You’ll want to strengthen your “girdle” of core-muscle support in your abdomen and lower back. Your doctor or physical therapist can recommend moves that are safe for you.
  • Consider an epidural steroid injection: Your doctor may suggest this type of injection, called an ESI, as a minimally invasive procedure that can reduce inflammation in the affected nerve. Relief usually lasts about three months, which may be enough for your back to heal so you don’t need a follow-up injection.

Surgical Procedures to Treat Herniated Discs

If you’ve tried non-surgical strategies and you still have symptoms after three months, surgery may be a good option. There are two main surgical procedures for a lumbar herniated disc.

Microdiscectomy

This procedure removes portions of the disc as a way to relieve the pressure on the spinal column. Microdiscectomy is sometimes called Microdecompression.

Laminectomy

In a laminectomy, a portion of the vertebral bone is removed. This creates more space for the spinal cord and nerves, so they aren’t being compressed.

There are two additional options for herniated discs in the cervical spine (the neck)

Anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR)

ACDF or CDR are both surgeries that remove the offending disc and insert either a bone graft (ACDF) and artificial disc (CDR) to stabilize the area.

Microlaminoforaminotomy

In this surgery, your surgeon will remove a small piece of bone from your vertebra to create more space for the pinched nerve(s).

After either surgery, most patients feel relief from symptoms like pain, numbness, and weakness right away. However, it could take several weeks or months for the nerves to fully heal.

The longer you wait, the more difficult it will be to get you back on track. If you’re hurting and not able to live your life the way you want, see your doctor, because there is a lot we can do to help.

DR.TURAJ YAZDI

SPINE SURGEON
The best way for disc surgery and it’s fundamentals
⭐Turaj Yazdi M. D.⭐

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