A herniated or bulging disc is a condition that can affect any part of the spine, especially the lower back. Sometimes it is called a protruding (bulging) or ruptured spinal disc. It is a common cause in sciatica, lower back pain, and other conditions. Low back pain can affect 60-60%. A herniated spinal disc can cause leg and back pain. Although herniated discs can be very painful, most people will feel better after some nonsurgical treatment.
Overview
A herniated Disc is when the gel core of a disc bursts through its tough outer wall. This is similar with the jelly doughnut filling. When disc material touches, presses, or presses on a spine nerve, it can cause back and leg pain, weakness, numbness and/or tingling. Rest, pain medication and spinal injections are all important steps towards recovery. Most people feel much better within six weeks. They can then go back to their daily activities. If the symptoms persist, surgery may become necessary.
Anatomy for the Discs
The spine is composed of 24 bones, or vertebrae. The lumbar, or lower back, section of your spine carries most of your body’s weight. The five lumbar vertebrae are L1 throughL5. The cushiony discs protect the vertebrae by acting as shock absorbers. The outer ring is known as the annulus. It is composed of a fibrous band that connects between the vertebrae. The nucleus is a place in the middle of each disc that contains a core of gel-filled material. Each level has two spinal nerves. Your spinal canal and spinal nerves work as a phone that sends messages back-and-forth from your brain, spine, and body to control sensation and movement.
What is a herniated disc located in the lumbar region?
Annulus: A herniated or ruptured disc is when the liquid-like core of the disc breaks through the disc wall. This causes chemical irritation to your spine nerves. The pressure of the herniated spinal disc causes pain and inflammation. Some relief may be experienced, while others might not feel any. The herniation should shrink over time. If the leg and low back pain do not disappear, most cases will resolve within 6 to 8 weeks.
Different terms can be used for a herniated spine. A bulging disc (also known protrusion), occurs when the disc innervation does not burst but forms an outpouching. This can press against nerves. True herniated (also known by slipped or broken discs) occurs when the disc annulus ruptures. The gel-filled middle is allowed to escape. Sometimes, the herniation can cause a fragment to be left. This means that the disc was completely removed from the spine.
The lumbar vertebrae are the most common location for herniated discs. This is the area where the spinal canals enter between the lumbar vertebrae. Then they join again to form your sciatic, which runs down the leg.
What are the signs?
There may be a variety of symptoms depending on where the herniated disc is located. A herniated spine in the lumbar area may cause pain radiating from your lower body, down one of your legs, or even to your feet. This is sciatica. It may feel like an electrical shock. This pain can be felt standing and walking as well as sitting. It can also be worsened if you bend, lift, twist, or move around. For disc pain, the best position is to lie flat on one’s back, with your knees bent.
Sometimes, the pain could be accompanied by numbness of tingling in your leg or foot. There might be cramping or muscle spasms down your leg or back. A weakness or loss in reflexes at the knee, ankle or leg may also occur. Foot drop may occur when your foot slides down during walking. If your legs feel weak, your bladder or bowel function is impaired, you should seek immediate medical attention.
How can this be?
An injury, improper lifting, and disc bulging may cause disc herniation or herniation. Or they can happen naturally. Ageing plays an important role. Your discs will become less resilient and more dry with age. The disc’s tough outer fibrous walls may start to weaken. A tear in the disc’s outer wall can cause nerve pain by causing the gel-like nucleus of the disc to burst or bulge. Early disc degeneration can also be caused by smoking, genetics and other recreational or occupational activities.
Who are the people affected?
People in their 30s or 40s are more likely to develop herniated discs. Middle-aged and elderly people are more at risk if they do strenuous exercise. Lumbar disc injury, which is more common than cervical neck (neck), is the most common reason for leg pain and lower back discomfort. Disc herniation most commonly occurs in the cervical region (neck), while it is less common in the upper-to-mid-back area (thoracic).
What is the process of diagnosing an illness?
Consult your family physician if you feel in pain. Your doctor will review your medical history to determine the cause of your pain and examine any injuries or other conditions. Your doctor will take a detailed medical history to identify any lifestyle problems that could be causing your pain. The doctor will conduct a physical exam to identify and treat the problem. Your doctor may order one, two, three, four, five, six, eight, nine, or ten of these imaging studies. Based on the results of your scans, an orthopedist, neurosurgeon or neurologist may refer you for treatment.
Magnetic Resonance Imaging or MRI is a noninvasive scan. It uses a magnet field combined with radiofrequency signals to show the soft tissues of your spine. Contrary to X-rays discs and nerves can be clearly viewed. The dye (contrastant) can be injected into your body. An MRI scan will reveal the location of nerve compression or disc damage. An MRI will detect bone growth, spinal cord tumours or abscesses.
MRI Herniated Disc
Illustration and MRI show a disc tear at the L5 vertebra. On MRI healthy discs look plump. Dry, degenerative discs seem greyish-flattened. Myelogram is a specialised X Ray, in which dye can be injected through a spinal needle into the spinal cord. The images can then be recorded using an X Ray fluoroscopy. A myelogram, which is created with a dye that appears white in X-rays, is called an X-ray fluoroscopy. This allows the doctor to view the canal, spinal cord, and surrounding structures in great detail. Myelograms may reveal nerve damage due to a herniated disc, bony overgrowth, or other conditions. A CT scan might be done after the test.
The CT scan is noninvasive and uses an X Ray beam and a PC to create 2-dimensional pictures of the spine. A dye (contrast drugs) may be injected into the bloodstream. This test can help determine whether a disc has been broken.
Electromyography (EMG) & Nerve Conduction Studies (NCS). EMG measures your muscle’s electrical activity. EMG tests use small needles to measure your muscle activity. It works in the same way as NCS to measure how fast nerves transmit an electronic signal. These tests can detect nerve weakness or damage. Your spine’s bony vertebrae are examined by X Rays. You can ask your doctor to show you if they are not close enough, arthritic change or bone spurs. This test does not diagnose a herniated spine.
What are the treatment options available?
Conservative nonsurgical therapy is the first step toward recovery. This could include rest, medication, and physical therapies. Hydrotherapy, epidural steroid shot (ESI), chiropractic manipulative and pain management can all be included. A team approach to treating back problems can make a difference in 80% of cases. This is possible within 6 weeks. If you are not responding to conventional treatments, your doctor could recommend surgery.
Non-surgical Treatment
- Self-care. Most cases of herniated discs will resolve in less than two days. Restricting your activities, applying heat therapy and taking prescription medications will all make recovery easier.
- Medication: Your physician may recommend medication. These include nonsteroidal pain relievers (NSAIDs), muscle relaxants, pain relievers, and steroids.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), are used for pain relief and to lower inflammation.
- Tylenol or Acetaminophen (Tylenol), can be used as a pain reliever, but they do not have the same anti-inflammatory property as NSAIDs. As well as causing stomach ulcers, NSAIDs and analgesics can also cause problems with the liver and kidneys.
- To control spasms, muscle relaxants such as methocarbamol or Robaxin, carisoprodol(Soma), and cyclobenzaprine/Flexeril may be prescribed.
- Steroids might be prescribed in order to reduce nerve inflammation. These can be administered orally (a Medrol dosing packet), with a tapering of the dose for 5 days. Within 24 hours, you can experience pain relief.
- Steroid injections: This procedure can be done under x-ray fluoroscopy. It involves the injection of corticosteroids, as well as an numbing medication in the epidural zone of the spine. The medication is administered directly to pain areas in order reduce nerve inflammation. 3). About half the epidural patients will experience some relief. However, most epidural patients will only experience temporary relief. Re-injections may be necessary in order to obtain full effects. Pain relief can last up to several years. Injections can also be used with home exercise programs or physical therapy.
ESI Lumbar
- During an ESI injection, the needle will be inserted from behind the affected area in order to reach and deliver steroid medication green to the inflamed neural roots.
- Physical therapy: This therapy will help you get back your full activity level and prevent injuries. Physical therapists can help with posture, lifting, and walking. They also strengthen your stomach muscles, legs, and lower back. You will be encouraged to stretch and improve flexibility of your spine and legs. Exercise and strengthening are essential components of your treatment. They should be a daily part of your fitness routine.
- Holistic therapies: Acupressure is a holistic treatment that can be used to manage pain and improve overall health.
Surgical Treatments
If your symptoms don’t improve after regular treatment, surgery for a herniated lumbar disc, also known as discectomy, may be an option. Surgery might be an option in cases where nerve damage has occurred, such as weakness or loss.
Microsurgical discectomy (or microdiscectomy): This is where a surgeon makes an incision in the center of your spine. To reach the damaged disc, the spine muscles have to be cut. A portion of bone must be removed to expose the nerve roots and disc. A special instrument is used to carefully remove any damaged disc that may touch your spinal cord. A discectomy can be a successful procedure, and patients are able to return to work within six weeks.
Microendoscopic discectomy involves minimally invasive procedures. A small incision will be made at the rear. Dilators are small tubes which can be used in order to expand the tunnel that runs from the vertebra. The bone portion must be cut to expose the nerve root and disc. A surgeon may use an endoscope, or a microscope, to remove the disc. This method causes a lesser amount of muscle damage than traditional discectomy.
Clinical Trials
Clinical trials, which are research studies that test new therapies such as diagnostics or procedures on people, determine whether they work and if it is safe. Medical care is improving through ongoing research. On the Internet, you will find information about current clinical studies including eligibility criteria and protocols as well as locations.
Recovery and Prevention
8 out of 10 people suffer from back pain at some stage in their lives. It generally resolves in six to eight weeks. A positive attitude, regular activity and prompt return-to-work are all important aspects of recovery. It is better for patients to be allowed to return to modified work or limited duties if it is not possible to do so. This activity is limited and can be prescribed by your doctor.
Prevention is the key to avoiding future recurrences.
- Proper lifting techniques recommended (see Selfcare for Neck and Back Pain).
- Proper posture during sitting, standing and moving is key.
- It is necessary to keep your abdominal muscles strong and avoid injury by following a well-designed exercise program.
- A well-designed and designed work area
- Healthy weight, lean body mass
- Positive attitude, stress management
- No smoking
Consider this..
There is a possibility of disc herniation occurring again in your lifetime. Nonsurgical and surgical treatments are available. Nonsurgical treatment may pose a risk as your symptoms may take longer for you to get under control. Patients who wait too late to seek nonsurgical care may experience less pain relief and better function compared to patients who decide to have surgery earlier. Research suggests that surgery performed after 9 to12 months is not more effective than surgery performed before 9 months. Before considering surgery, discuss with your doctor how long you should continue with nonsurgical treatments. Surgery comes with risks. Every procedure has some risks. These risks include bleeding, infection, or reactions to anaesthesia.
Operation to repair a herniated or bulging disc can bring about complications.
- Nerve injury
- Infection
- Tears of the nerves’ sac (dural tear).
- Hematoma causes nerve compression
- Recurrent disc herniation
- Additional surgery might be required
Outcomes
The overall outcomes of microdiscectomy surgery are very good. Patients often notice greater improvements in their leg pain after microdiscectomy surgery than they do their back pain. After a few more weeks, most patients can resume normal daily activities. Pain is usually the first sign that things will start to improve. The next step is to improve your overall strength, and feel more comfortable. Recent research has focused specifically on disc herniation. Your doctor can help you understand the differences between surgical and nonsurgical treatment.
I have a herniated disc in my lumbar. What’s next?
Lumbar herniated lumbar disc pain can often seem sudden or sharp. The most telling sign that you have a herniated spine is leg pain. This happens when the pressure on your sciatic nerve causes pain in the lower part.
Some steps can be taken at home to ease your symptoms. Nonsteroidal antiinflammatory drugs, such as Ibuprofen, can be used to relieve stiffness. It is also possible to apply heat and ice to the affected region. The pain may be relieved by resting for a bit. But, you need to be aware of the fact that prolonged time in bed can cause it to get worse.
A spine specialist may be available to assist you. The majority of cases of herniated spines are not serious and do not require any surgery. An expert can help you to develop a pain management strategy and treatment plan. This will allow you to feel better sooner. There are many options available to you for reducing your pain and improving mobility.
How do you determine if your herniated spinal disc should be surgically repaired?
If you continue to feel unwell even after several weeks’ worth of non-surgical treatments, your doctor may recommend surgery. This can be done with minimally invasive procedures. It will remove the herniated material and leave the rest intact. This will allow you to heal your disc with minimal pressure.
We will also look out for neurologic impairments. This refers to a condition that causes a particular part of your body to not function properly due to compression of your spine cord or nerves. Numbness, tingling, or difficulty walking can all be symptoms. Permanent nerve damage can be avoided by having surgery as soon as possible. If you feel that your bladder or bowel control is impaired, it’s important to immediately seek emergency care.
Although herniated or bulging discs can be discomforting, most can be treated non-surgically. It is possible to fix persistently painful conditions without having to go under the knife. You will be able to resume your daily activities. My goal to assist you in achieving the results you desire is my goal.