What is Lumbar Disc Disease (Herniated Disc)?
The vertebral column, or backbone, is made up of 33 vertebrae that are separated by spongy discs. The spine is divided into 4 areas:
- Cervical spine: The first 7 vertebrae, located in the neck
- Thoracic spine: The next 12 vertebrae, located in the chest area
- Lumbar spine: The next 5 vertebrae, located in the lower back
- Sacral spine: The lowest 5 vertebrae, located below the waist, also includes the 4 vertebrae that make up the tailbone (coccyx)
The lumbar spine consists of 5 bony segments in the lower back area, which is where lumbar disc disease occurs.
- Bulging disc. With age, the intervertebral disc may lose fluid and become dried out. As this happens, the spongy disc (which is located between the bony parts of the spine and acts as a “shock absorber”) becomes compressed. This may lead to the breakdown of the tough outer ring. This lets the nucleus, or the inside of the ring, to bulge out. This is called a bulging disc.
- Ruptured or herniated disc. As the disc continues to break down, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or herniated, disc. The fragments of disc material can then press on the nerve roots located just behind the disc space. This can cause pain, weakness, numbness, or changes in sensation.
Most disc herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra (the L4-5 and L5-S1 levels).
What causes lumbar disc disease?
Lumbar disk disease is caused by a change in the structure of the normal disc. Most of the time, disc disease happens as a result of aging and the normal break down that occurs within the disc. Sometimes, severe injury can cause a normal disc to herniate. Injury may also cause an already herniated disc to worsen.
What are the risks for lumbar disc disease?
Although age is the most common risk, physical inactivity can cause weak back and abdominal muscles, which may not support the spine properly. Back injuries also increase when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy lifting and twisting of the spine can also cause back injuries.
What are the symptoms of lumbar disc disease?
The symptoms of lumbar disc disease vary depending on where the disc has herniated, and what nerve root it is pushing on. These are the most common symptoms of lumbar disc disease:
- Intermittent or continuous back pain. This may be made worse by movement, coughing, sneezing, or standing for long periods of time
- Spasm of the back muscles
- Sciatica – pain that starts near the back or buttock and travels down the leg to the calf or into the foot
Muscle weakness in the legs
- Numbness in the leg or foot
- Decreased reflexes at the knee or ankle
- Changes in bladder or bowel function
The symptoms of lumbar disc disease may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.
How is lumbar disc disease diagnosed?
In addition to a complete medical history and physical exam, you may have one or more of the following tests:
- X-ray. A test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Magnetic resonance imaging (MRI). A procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.
- Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
- Electromyography (EMG). A test that measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle.
How is lumbar disk disease treated?
Typically, conservative therapy is the first line of treatment to manage lumbar disc disease. This may include a mix of the following:
- Bed rest
- Education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)
- Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
- Weight control
- Use of a lumbosacral back support
- Medicine to control pain and relax muscles
If these measures fail, you may need surgery to remove the herniated disc. Surgery is done under general anesthesia. Your surgeon will make an incision in your lower back over the area where the disc is herniated. Some bone from the back of the spine may be removed to gain access to the disc. Your surgeon will remove the herniated part of the disc and any extra loose pieces from the disc space.
After surgery, you may be restricted from activity for several weeks while you heal to prevent another disc herniation. Your surgeon will discuss any restrictions with you.
What are the complications of lumbar disc disease?
Lumbar disc disease can cause back and leg pain that interferes with daily activities. It can lead to leg weakness or numbness and trouble with bowel and bladder control.
Can lumbar disc disease be prevented?
Maintaining a healthy weight, participating in regular exercise, and using good posture can lessen your risk for lumbar disk disease.
Living with lumbar disc disease
Conservative therapy requires patience; but sticking with your treatment plan can reduce back pain and minimize the chance of worsening pain or damage to the disc. Conservative measures and surgery can both take time to be effective.
Key points about lumbar disc disease
- Lumbar disc disease may occur when a disc in the low back area of the spine bulges or herniates from between the bony area of the spine.
- Lumbar disc disease causes lower back pain and leg pain and weakness that is made worse by movement and activity.
- The first step in treatment is to reduce pain and reduce the risk of further injury to the spine.
- Surgery may be considered if the more conservative therapy fails.
A herniated disc is a common injury that can affect any part of the spine. A herniated disc can cause severe pain and other problems in the arms or legs.