Understanding Lumbar Disc Herniation

By Ignacio Badiola, MD

National Spine & Pain Centers

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Understanding Lumbar Disc Herniation

Many patients with back pain, leg pain, or weakness of the lower extremity muscles are often diagnosed with a herniated disc. When a disc herniation occurs, the cushion that sits between the spinal vertebrae is pushed outside its normal position. Also known as a slipped or prolapsed disc, the condition can be excruciating, and it can happen to anyone. An accurate diagnosis becomes critical to determining the most effective treatment.

A herniated disc in the lumbar spine can put pressure on one or more of the spinal nerve roots that compose the sciatic nerve. Thus, the brain may interpret sciatica pain anywhere from the lower back all the way down the leg into the calf or foot.

A herniated disc causes variable symptoms, depending upon the level and location of the injured disc. Low back pain and/or sciatica are the most common symptoms, varying in intensity from mild to severe. The onset of symptoms may be sudden or gradual and may include sharp, burning leg pain, tingling, and numbness in the buttocks, legs, or feet. Certain movements such as bending forward or twisting can intensify the pain as can prolonged sitting, sneezing or coughing. Weakness in one or both legs, and in rare circumstances, loss of bladder or bowel control may occur, which would be cause to seek immediate medical attention.

With the aging process, discs naturally dehydrate and lose their resiliency making them more susceptible to wear. Other factors that can weaken or damage discs include heavy or incorrect lifting, poor posture, repetitive twisting movements, high-impact sports, smoking, obesity and traumatic injury

A complete clinical evaluation with thorough medical history and physical exam is the first step in diagnosis. Your physician may recommend additional diagnostic testing, such as EMG testing and CT or MRI imaging to verify the location and extent of damage.

Nearly 90% of patients with disc herniations don't require surgery. The symptoms often resolve with conservative measures such as activity modification, analgesics, anti-inflammatory medications, and physical therapy. In cases of severe or persistent pain, epidural nerve block injections may be employed.

During an epidural nerve block, anti-inflammatory medication is injected around the inflamed disc and nerve to reduce the irritation and relieve pain. This is usually an office-based procedure with minimal down time and may be performed up to three times, typically two to three weeks apart. Epidural nerve blocks may be done in conjunction with physical therapy to prevent recurrence of disk injury. The vast majority of patients, in excess of 90%, treated for herniated discs experience improvement with pain and mobility.