Lumbar disc herniation

What is a lumbar disc herniation?

A significant percentage of the population suffers from a herniated disc at some point in their lives.

A herniated disc, which can occur anywhere in the spine, is most common in the lower back and, depending on where it is located, can cause pain, numbness or weakness in an arm or leg.

Lumbar disc herniation is often referred to as “sciatica” because of the symptoms it causes in the leg: severe pain, numbness, weakness and/or tingling in the affected leg.

What are the causes of lumbar disc herniation?

The lumbar spine is made up of five vertebrae, numbered L1 to L5. Between each of these vertebrae is an intervertebral disc that acts as a shock absorber. Intervertebral discs have a soft, jelly-like centre (nucleus pulposus) surrounded by a thicker, tougher outer layer (annulus fibrosus).

Lumbar disc herniation occurs when the nucleus pulposus bulges through a fissure/tear in the annulus fibrosus. This can put pressure on the nerve roots coming out of the spine and cause pain, numbness and weakness in the leg.

One of the most common causes of lumbar disc herniation is accumulated wear and tear related to ageing (disc degeneration). As people age, discs become less elastic and more prone to rupture, even with slight strain or twisting. This natural wear and tear can be accelerated or aggravated by obesity, lack of exercise and smoking.

At other times, injuries can occur from heavy lifting, twisting the back or a blow to the back.

What are the symptoms of a herniated lumbar disc?

Symptoms of lumbar disc herniation may vary from person to person. The most common symptom is back pain, which may radiate down the leg. Other symptoms may include numbness, tingling or weakness in the leg. In severe cases, lumbar disc herniation may cause urinary or fecal incontinence. In these cases you should contact your surgeon as soon as possible or go to the emergency department of your hospital.

How is a herniated lumbar disc diagnosed?

Diagnosis of lumbar disc herniation is made by a combination of clinical evaluation and diagnostic testing. The spine doctor will perform a physical examination and ask about symptoms. The main diagnostic test will be an MRI, although X-rays or CT scans may also be ordered.

What is the treatment for lumbar disc herniation?

Many people have no symptoms of a herniated disc. For those who do have symptoms, they tend to improve over time. Treatment will depend on the severity of the patient’s symptoms: if symptoms are not severe, treatment options are usually conservative, with pain analgesia, physiotherapy and/or infiltration.

What is the surgical intervention for lumbar disc herniation?

Although not the most common, in severe cases of lumbar disc herniation and when other treatments have not been effective, or in case of medical emergency (limb claudication, incontinence, mainly), surgical treatment may be necessary.

The usual procedure is microdiskectomy
microdiscectomy
Microdiscectomy is a minimally invasive surgery that involves the removal of a portion of the herniated intervertebral disc, with the aim of relieving pressure on the nerves and relieving symptoms (back pain and radiation to the extremities).

This procedure can be performed in a minimally invasive manner either endoscopically or through a minimal incision (1-2cm). The surgery is usually performed under general anaesthesia and often involves a short hospital stay of 1-3 days, depending on the patient’s situation.

What is the recovery after a lumbar disc herniation?

The patient will usually present immediate improvement of symptoms (radiating pain, numbness, …). He or she will be able to return to basic activities of daily living, although with limited activity and lifting restrictions for the first 2-3 weeks.

Pain medication may be prescribed and early mobilisation exercises may be performed to prevent complications, which may include strengthening exercises and stretching for the back, as well as physical therapy.

Full recovery can vary, but many patients are able to return to normal activities within a few weeks.

It is important to follow medical advice and keep follow-up appointments for a successful recovery.

Can a herniated lumbar disc be prevented?

Although it is not always possible to prevent a herniated lumbar disc, adopting healthy lifestyle habits and following a few tips can significantly reduce the risk:

Exercise regularly to strengthen the muscles of the back and abdominal belt; and maintain good body posture, paying special attention when sitting and lifting objects. It is also recommended to maintain a healthy weight and avoid smoking, which can weaken the intervertebral discs.

Lumbar disc herniation can be a painful and debilitating condition, but there are many treatment options available. At BSI we help our patients understand the symptoms and their causes, and provide the most appropriate treatment for each case.