A herniation occurs when the outer band of the disc breaks or cracks, and the gel-like substance from the inside of the disc leaks out, causing pressure on the spinal canal or nerve roots. In addition, the nucleus releases chemicals that can irritate the surrounding nerves causing inflammation and pain.
Most lumbar disc herniations result from sudden stress, such as from an accident. Sometimes they occur gradually, over weeks, or even months. The risk factors that can contribute to the chances of a disc herniation include:
- Aging: As we get older, discs gradually dry out, losing their strength and resiliency.
- Lifestyle choices: Poor disc health is associated with a number of lifestyle factors, including a lack of physical activity, an unhealthy diet, excess body fat, and smoking.
- Poor posture and incorrect repetitive lifting or twisting can place additional stress on the lumbar spine.
Symptoms
Symptoms of a lumbar disc herniation may include the following:
- Dull or sharp pain in the lower back, intensified by movements or activities such as bending, coughing, or sneezing.
- Muscle spasms or cramping.
- Sciatica (pain, burning, tingling, and numbness that extends from the buttock into the leg or foot).
- Weakness or loss of leg function.
Treatment
Non-Surgical Treatment
- Pain medications such as anti-inflammatories to reduce swelling and pain, muscle relaxants to calm spasms, and occasionally narcotic painkillers to alleviate acute pain.
- Heat/cold therapy, especially during the first 24-48 hours.
- Physical therapy exercises such as gentle massage, stretching, and strengthening exercises decrease pain and increase flexibility.
- An epidural injection of anti-inflammatory medication. This is for patients who have severe pain or significant leg pain.
Surgical Treatment
In order to alleviate nerve pressure and leg discomfort, surgery often entails removing a portion or the entire damaged disc. This is called a microdiscectomy. This procedure can often be done in our practice using minimally invasive techniques. Minimally invasive surgery involves using small incisions and specialized technology. As they alleviate muscle trauma and blood loss, microdiscectomy and minimally invasive techniques typically result in a faster recovery period for the patient than conventional treatments.
Spine fusion is rarely necessary when a disc is herniated for the first time. If necessary, the space left by the removed disc may be filled with a bone graft. The bone graft or a bone substitute is used to join or fuse the vertebrae together. In some cases, specially designed instrumentation (such as rods or screws) may help promote fusion and add stability to the spine.
In addition to a discectomy, a portion of the bone covering the nerve may also need to be removed. This procedure is called a laminectomy.