HERNIATED DISC (LUMBAR)
Herniated disc is a condition in which the outer fibers (annulus) of the intervertebral disc are damaged causing the soft inner material of the nucleus pulposus to rupture out of its space. A herniated disc, common in the lower back (lumbar spine) occurs when there is a tear in the outer lining of the disc (annulus fibrosus). This causes the inner jelly-like material (nucleus pulposus) to leak out and place pressure on the adjacent spinal nerve root. It is the most common cause of low back pain and pain that radiates down the leg (radiculopathy).
The most common signs and symptoms of lumbar disk herniation’s are back pain that radiates to buttocks and legs, numbness in the leg or foot, weakness in the leg or foot, and rarely, loss of bowel and bladder control.
Proper diagnosis of the condition requires a complete medical history and a careful physical examination by your physician. Some of the additional diagnostic tests your doctor may suggest include:
X-ray of the middle-back: X-rays help to detect the amount of wear and tear present and to rule out other conditions.
CT and MRI scan: These tests are done to confirm the diagnosis of herniated disc.
Conservative treatment includes pain medications, physical therapy, and avoiding strenuous activity if the pain is severe.
Epidural Steroid Injection (ESI): ESI can be considered if the pain is intolerable even with medications and rest.
Lumbar microdiscectomy is a surgical procedure done to remove a herniated part of the disk and any fragments that are putting pressure on the spinal nerve. This surgical procedure involves use of a surgical microscope and microsurgical techniques to gain access to the lumbar spine. The microscope magnifies and illuminates the area of operation. Only a small portion of the herniated disc that pinches on the nerve roots is removed.
Lumbar stenosis is the compression of spinal nerves caused by narrowing of spinal canal and it is one of the common causes of low back pain. Spinal stenosis can also affect the spine in neck region. The symptoms include back pain, burning or aching type of pain in buttocks that radiates to the legs (sciatica), weakness in the legs or "foot drop”. One of the causes for spinal stenosis is the ageing and other causes include Paget’s disease, achondroplasia, spinal tumors and spinal injuries. As age advances the chances of developing osteoarthritis, disc degeneration and thickening of ligaments may increase and these conditions cause spinal stenosis.
Lumbar spinal stenosis may be treated with conservative treatment approaches such as use of pain medications, physical therapy, steroid injections, or acupuncture. In chronic cases, surgery may be required to treat the condition.
Physical therapy: Physical Therapy involves stretching exercises, massage, and lumbar and abdominal strengthening.
Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief and reduce swelling.
Steroid injections: Cortisone steroid injections are given around the nerves or in the "epidural space” to decrease swelling and pain.
Acupuncture: Acupuncture can be helpful in cases where the pain is less severe.
Chiropractic manipulation: Chiropractic manipulation can be done in some cases but not when there is co-existing osteoporosis or herniated disc because these cases increase the symptoms or cause injuries.
Surgery is considered for patients in whom the pain and weakness is causing debilitation such as inability to walk for a long time. The two main surgical procedures to treat lumbar spinal stenosis are laminectomy and spinal fusion.
Laminectomy: This procedure involves removal of the bone, bone spurs, and ligaments that compress the nerves.
Spinal fusion: In this procedure, two or more vertebrae are permanently fused together.
Back pain or backache is the pain felt in the back that may originate from muscles, nerves, bones, joints or other structures in the spine. Back pain is one of the most common medical problems experienced by most people at some time in their life. Back pain can be acute, usually lasting from a few days to a few weeks or chronic, lasting for more than three months.
Back pain can occur as a dull, constant pain or a sudden, sharp pain. Back pain may be confined to one area or may radiate to other areas such as the arm and hand, the upper back, or the lower back and might radiate into the leg or foot. Other than pain, you may have weakness, numbness or tingling in your arms or legs, caused from damage to the spinal cord.
Athletes participating in sports such as skiing, basketball, football, ice skating, soccer, running, golf or tennis are at greater risk of developing back pain. During these sport activities, the spine needs to bear more stress, take more pressure, undergo twisting and turning, as well as bear more bodily impact. This may cause strain on the back that can result in back pain. Athletes are at high risk of back pain both from trauma and from overuse injuries, especially in sports requiring hyperextension.
Common causes of back pain in athletes include:
Musculoligamentous strain: It is the most common sports injury caused by injury to the soft tissues around the spine.
Spondylolysis: It is most commonly found in athletes who participate in sports such as gymnastics, pole-vaulting and football. All these activities require frequent hyperextension of the lumbar spine.
Spondylolisthesis: It is a condition of the spine which occurs when one vertebra is displaced or has slipped forward over the other below it.
Herniated nucleus pulposus: When injury occurs, the central core of the disc is pushed through a tear in the outer hard layer of the disc, causing a bulge and pressing on nearby nerves. If the herniated disc presses on a spinal nerve, it can cause back pain.
Other causes include growth-related problems such as scoliosis and Scheuermann's kyphosis.
Your physician will diagnose back pain by asking appropriate questions or by taking a history of your problem and examining your spine. A complete examination includes examination of the signs of unusual curves of the spine, a rib hump, a tilted pelvis, and tilting of the shoulders and a test of your sensations. Other diagnostic tests may be needed to confirm the diagnosis.
Treatment for back pain is usually non-surgical and includes:
Anti-inflammatory medications, or NSAIDs are recommended to provide relief from pain
Cold packs, heat packs or both applied to the back to help ease much of the discomfort and relieve stiffness as well the pain
Sleeping with the pillow between the knees while lying on one side or placing the pillow under your knees when lying on your back may help relieve back pain
Exercises to strengthen your trunk and back muscles
These measures help relieve your back pain. However, in certain conditions the pain may not be resolved and may require surgical treatment. Your physician will decide on the appropriate surgery based on several factors.
The sciatic nerve is a large nerve that originates in the lower back, running along the hip and back of the leg and branching off at the knee. Compression or damage of this nerve can cause pain that radiates from your lower back to the buttocks, to your legs. The intensity of pain varies from mild pain to sharp or burning pain. This may also be associated with numbness, tingling, muscle weakness or burning sensation in the hip, leg and foot. The pain is usually intensified with prolonged sitting, and exaggerated by coughing, laughing or sneezing. In rare cases bladder and bowel function may also be affected (cauda equine syndrome) requiring emergency medical intervention.
Some of the common causes for the compression of the sciatic nerve may include herniated disc (damage to intervertebral disc), bone overgrowth (spurs), piriformis syndrome (piriformis muscle compresses the sciatic nerve), or injury and tumors of the lumbar spine. Other conditions of the lumbar spine that may cause sciatica include degenerative disc disease (degeneration of vertebral discs), spinal stenosis (narrowing of the spinal canal), diabetes and spondylolisthesis (vertebra slips out). Poor posture, obesity and prolonged sitting can also lead to sciatica.
Diagnosis of the exact underlying cause is crucial in determining effective treatment. Diagnosis of sciatica includes a medical history and physical examination to evaluate muscle weakness, numbness and abnormal reflexes. Imaging tests such as X-rays, CT and MRI scans are ordered to confirm on the diagnosis.
Sciatica often resolves by itself, without any treatment. Your doctor may prescribe pain, anti-inflammatory, anti-seizure, antidepressant or muscle relaxant medications. Conservative management of sciatica includes activity modification, ice or heat application, spinal injection and physical therapy. Spinal surgery may be indicated if the symptoms do not respond to a conservative approach.