Bulging discs and herniations at the lower back are most common at the L4–L5 segment or at the level. The L4–L5 is located at your beltline. It is responsible for 95% bending or twisting movements involving your waist. Because they perform load-bearing functions, which support the upper bodies, this segment is the most heavily loaded. Because of the excess stress it is subject to, the L4–L5 section is often a site for spinal disc bulges. This article will explain the L4–L5 spinal segment in detail. It will help you to understand your condition and how you can recover without having to undergo surgery or inject any drugs.
A common reason for chronic and acute lower back pain (backaches), is the L4–L5 spinal segment. A L4-L5 bulge in the disc can cause sciatic-like symptoms by impinging nerves running down the legs. A pinched nerve can be caused by a slipped disc. A L4–L5 disc bulge (or slip-disc) in the L4-L5 region can cause severe health issues such as impotence and reproduction issues. It can also lead to infertility, loss or control of the bowel or bladder, paralysis in one or both of your legs, and even death. A pinched nerve can occur at the L4–L5 levels due to bone-spurs (spondylosis), or ligament thickening (“hypertrophy of ligamentum flavum”).
This article provides detailed information on the L4-L5 segment and common conditions that may arise. No matter what the cause of the L4-L5 spine segment, it can be treated with surgery or injections. Accurate diagnosis and corrective treatment that target the root cause are crucial to your recovery. Before we discuss disorders and possible treatment options, let us first talk about the low back (lumbar spinal).
The Lumbar Spine: What Does It Do?
Sometimes referred to as the lower spine, the lumbar spinal column is also known as the lower. It is a complex structure. The total number of vertebral bones in the lumbar spinal column is five. Each bone is attached to an intervertebral. This allows for dynamic movement and weight bearing. The L4–L5 spinal disc has the second-lowest space. The L5–S segment is the lowest. The L4–L5 spinal segment, which accounts for 95% bending at your waist, is the most crucial of all lower back segments. Many back pain patients have L4/L5 disc bulge disorders.
A herniated spine is the main cause of spinal canal disability and stenosis. This disc can also be prone to degenerative changes, such as disc herniation (slip or slipped disc).
How does the Spinal Disc get damaged?
Intervertebral discs have two main parts. The outer rim is the annulus fibrosus and the inner portion is the nucleus pulposus. Repetitive trauma, constant axial load of the spine, injury, and weakness in the lower back muscles may cause the inner portion (the nucleus pulposus), to protrude from the outer ring. There are many types of slipped discs, such as disc bulge or disc herniation, prolapsed disc, sequestrated disc, extruded and fragmented disc.
An impingement can occur on an existing nerve root. An L4 disc herniation could impinge multiple traversing nervous roots in severe cases. This includes the L5 and S1 nerve roots. This means that one slip disc can pinch many nerve roots and even the spine. L4-L5 is the preferred option for many because of spinal cord compression and nerve root impingement. We would like to discuss some of the symptoms of L4–L5 nerve root impingement before we provide information about L4–L5 spine surgery.
Common Problems in the L4-L5 Spinal Sections
Below are some common causes of low back pain.
- Muscular and ligamentous conditions
- Disorders of facet or spinal joints
- Slipped disc (slip disc)
- Spinal canal stenosis
- Foraminal Stenosis
- Muscle & Ligament Diseases at L4 – L5
Ligamentum flavum injuries, disorders, and damage are all common issues that can cause concern. L4-L5 segment issues are common. They affect almost everyone over the age 40. However, it is not enough to have muscles or ligament problems.
Damage to muscles or ligaments can cause back pain. Ligamentum flavum refers to a ligament that has muscular characteristics. This means that it has contractile properties. Injury to ligamentum Flavum causes hypertrophy in ligamentum Flavum which compels the nerves and spinal cord.
Spinal Joint Disorders
As we have already mentioned, the L4–L5 spinal segment is both the most mobile and least burdened in the lower back. These segments are further burdened by sitting and weight bearing. The spine’s spine joints, or facet joints, are lined with cartilage containing synovial membranes. Fluid accumulation can occur in joints due to stress from sitting or standing. Joint degeneration (facet hypertrophy), bone spurs and arthritis are both caused by excessive fluid accumulation.
L4-L5 Slip-Disc (Slipped Disc)
Bulging, herniated discs, protruding and prolapsed discs can be medical terms that mean a slipped or slipped disc. An example of a L4/L5 slip-disc is when the spinal disc at L4/L5 wears down or becomes degenerate.
The L4–L5 segment is the most likely site for spinal disc damage, disc bulge, or a slipped disc. L4-L5 slip discs can herniate or bulge and compress the spinal cord fibers and the thecal sac. It is possible to cause serious injury or compression of a nerve or spinal cord fibers by the slightest bit. Nerve compression can cause nerve degeneration. Paralysis, nerve weakness, and pain can all be caused by degenerative changes in the nerve.
A slipped disc or bone-spur can cause a compressed nerve. A compressed nerve can also be caused by bone-spurs, arthritis, and spondylosis. Whatever the cause, compressed nerves should be treated immediately, particularly at the L4-L5 section of the lower back.
L4-L5 degenerative spondylolisthesis can be either congenital (or acquired) and involves one or more vertebrae moving forward from the ones below. Slippage of one vertebra to the other (spondylolisthesis), is graded according to its severity. :
- Grade I spondylolisthesis. Forward slippage of less that 24%
- Slippage of 25-49% for Grade II spondylolisthesis
- Grade III spondylolisthesis. Slippage of 50-74%
- And A Grade IV Spondylolisthesis: Slippage of over 75%
Spondylolisthesis can be associated with any co-condition. The most common conditions with spondylolisthesis include:
- Hypertrophy and ligamentum flavum – Thickening of a spine ligament within the canal
- Facet Hypertrophy – Bone spurs and arthritis
- Disc Degeneration – Wear and tear to spinal discs
- Joint Degeneration: Wear and tear on spinal joints
- Spinal canal swelling: shrinkage in spinal canal size
- Foraminal Stenosis is: The shrinkage of the spaces where spinal nerves come out
As you can see, spondylolisthesis could be a major problem. Spondylolisthesis can result in leg pain, back pain and sciatica at the L4-5 spinal segment. It can also cause weakness and paralysis. The acquired and degenerative forms are both treatable without surgery.
What is L4-L5 Spondylosis and How Can It Be Treated?
Spondylosis, a term that refers to spinal disc disease and spinal joint disorders that can lead to nerve root irritation, is somewhat loose. A common area of spondylosis is the L4–L5 segment. Spondylosis symptoms at the L4–L5 segment vary. The severity of nerve damage caused by spondylosis can affect the symptoms. However, if you do not experience pain, it does not necessarily mean that your spondylosis is absent. Most spondylosis symptoms (cause of pain) are not present until the later stages. Below we have listed common symptoms associated with spondylosis L4-L5.
- Mild L4-L5 Spondylosis causes back discomfort.
- Moderate L4-5 spondylosis may cause back pain, pain at the buttocks or hips, legs, foot, or leg. You may feel numb, tingling or weak in your legs, feet, or toes.
- Severe L4-5 spondylosis results in severe back pain, weakness and problems with the bladder, legs, bladder, and bowels. It can also cause erectile dysfunction in men and female reproductive issues. If justify untreated, it can cause paralysis or partial paralysis.
What Are the Dangers of Canal Stenosis at Level L4-L5?
Spinal stenosis, a common cause for disability and pain, is very common. The L4-L5 area is the most common location for spinal canal stenosis at the lower back. Spinal stenosis can be caused by premature wear of the spinal joints, muscles, ligaments and discs. The progressive disorder of spinal canal shrinkage, or stenosis, is called. It means that the shrinkage will progress once it starts.
A complete or partial impairment of the spinal cord or nerves is a sign of progression. Any reduction in the length of the spinal canal is cause for concern, especially if it occurs at the L4 or L5 levels. They are dangerous because they cause weakness, paralysis, infertility, loss or control of the bladder and bowel.
L4-L5 Foraminal Stenosis
Canal stenosis refers to a shrinkage of the spinal canal (housing the spinal cord). Foraminalstenosis refers, in part, to the narrowing or shrinkage of the opening between the segments of the spine. The foramina (or opening) shrinks when there is spinal disc degeneration, spine hypertrophy, joint degeneration (facet hypertrophy), ligamentous issues or bone spurs. L4-L5 foraminal stenosis is the main cause of leg pain, sciatica and leg pain.
Symptoms Of Lumbar Spinal Segment (L4-L5)
Patients may feel lower back pain radiating to one or both sides of their lower limbs. A variety of symptoms include tingling, numbness (pins & needles), burning sensations in the foot and legs, and numbness (pins & needles). In extreme cases, a L4-L5 slipped disc can lead to weakness in the feet and legs. Some individuals may not be able to walk and others may have trouble standing. People who are unable to stand or walk may be affected by “foot fall.”
Patients suffering from foot drop often have a high steppage gait. This is when they raise their thighs and walk as if climbing the stairs. The foot also has a slapping barrier, which means that their foot touches the ground when they walk. A drop foot can be a serious condition that results in nerve damage or degenerative changes. The severity of a slipped disc will affect the degree of injury. People with a slipped disc should try their best to get the necessary non-surgical care as soon as possible.
Disc problems are among today’s most common back problems. However, they can also prove to be some of the most severe and painful. L4-L5 disc problems are especially common. They can lead to additional, severe symptoms that can disrupt your daily life and cause you to run for help. You aren’t sure if you have an L4/L5 slipped disc issue or another problem. Here are three signs to watch out for.
Chronic Lower Back Pain
The lumbar region pain can be interpreted as many things. However, the symptoms of pain may not be the only thing that will help you diagnose the problem. “Pain could be the first sign that you have L4/5 bulging discs. There may be pain in your lower back or near your top of the pelvis. You can feel the pain increase if the nerve is compressed near the spine.
“Avoiding activities that involve bending over or sitting for extended periods of time will increase your pain.” You might have difficulty sleeping at night.
Leg Weakness or Pain
Sciatica refers to the leg pain often caused by an L4/L5 disc problem. It is one of the easiest signs that disc problems could be causing your back pain. The pain radiating down the leg along the sciatic nerve is very unpleasant and often leads to back pain sufferers calling a doctor.
However, sciatica pain can present in other ways. “The symptoms can be described as dull and sharp, burning, aching, stabbing, or painful.
It can worsen if you’re sitting for too long or if your coughing, laughing, or sneezing is excessive. The situation may be aggravated by walking.
Tingling and Numbness
Your L4-L5 region of the disc may cause tingling or numbness if it presses on a nerve. WebMD says the numbness could be felt in “one leg” and can start at the buttock or behind your knee and go all the way to the thigh or ankle.
Livestrong stated that pain in the foot is most common if the nerves become affected. “Tingling, numbness or other symptoms can vary depending on your back position.
Anatomy of L4-L5 Spinal Motion Segment
These structures make up the L4–L5 motion segment.
L4 and the L5 vertebrae. Each vertebra has a vertebral structure: a frontal vertebral body and a rear vertebral ar. The vertebral arches have three bony protrusions. One is a prominent spinous region in the middle, and two are transverse processes to either side. The lamina is located between the spinous process, the transverse process and the vertebral body. The pedicle is located between the transverse process (vertebral body) and the lamina. The vertebrae are connected by facet joints (zygapophyseal junctions), which allow for smooth movement between their joint surfaces.
L4 and L5 vertebral bodies are higher in the front than they are in the back. Bony endplates cover the vertebral bodies at their upper and lower ends, helping to resist compression loads.
L4-L5 intervertebral disc. The disc is made of a gel-like material called nucleus pulposus and is enclosed by a fibrous ring called annulus fibrosus. It lies between the L4/L5 vertebral bodies. This disc acts as a shock absorber and cushion to prevent the vertebrae grinding against each other during spinal movements.
The L4/L5 disc height is important in maintaining the lordosis of the lumbar spine.
L4 spinal cord. The L4 spinal neural roots exit the spinal cord through small bony foramina (intervertebral foramina) located on the justify and the right sides of the spinal canal. These nerve roots are joined with other nerves and form larger nerves which travel down each leg.
L4 dermatome refers to an area of skin which receives sensations via the L4 spinal nerve. It covers parts of the thigh (leg), knee and foot.
The L4 myotome includes parts of many muscles from the pelvis, hip, leg and foot.
The L4–L5 motion segment is a bony enclosure that houses the cauda-equina (nerves running down from the spinal cord) and other delicate structures.
Common Problems at L4 and L5
Some of the more common injuries or disorders that can occur in the L4-L5 segment include:
Facet joint problems. Facet joint problems can arise from the high mobility of L4-L5 because of the instability of the facets and synovial cyst (fluid filled sac).
Problems with the disc. Degeneration is a major concern for the L4/L5 disc. This could be caused by increased loads on the L4-L5 disc and reduced movement in the lower segments. The lumbar spine may experience a decrease in its lordosis due to disc degeneration.2 Degeneration and injury can also lead to disc herniation.
Spondylolysis. Pars interarticularis fractures can occur at the level of L4-L5 due to high compressive loads.2 It can be on either one or both of these sides. The bone is not likely to break but can become stressed. This condition is known as a pars stress response.
Degenerative spondylolisthesis. As we age, the angle of our L4-L5 facet joints changes. This makes this level more susceptible to spondylolisthesis. Forward slippage of L4 and L5 in people over 60 years old.
Spinal stenosis. A narrowing (stenosis), of the bony openings for the nerves may occur due to bone spurs (abnormal growth of bone) or other degenerative processes. This could cause nerve root compression in the area of stenosis.
External trauma such as motor vehicle accidents or falls may cause fractures and/or dislocation of the facet joints. Rarely, tumors may develop in the L4-5 vertebrae or spinal segment.
Non-surgical Treatments Can Relief be Obtained for Pressure on Nerves Caused by Slipped Disc
L4-L5 Lumbar discs can place different degrees of pressure on the nerves if they bulge, herniate, or protrude. In other words, a slip-disc or slipped disc can put significant pressure on nerves that exit the spine. In order to relieve nerve pressure, spine surgeons may attempt to either destroy the nerve with Radiofrequency Ablation (RFA/RF Neurotomy) or any other form of spine surgery. However, surgery has not been successful in the long term. Many people who have had L4-L5 disc surgery return for more.
Surgery is not the best option for treating nerve pressure from bulging, herniated, or extruded discs in the lumbar spine.