Lumbar herniated disc is one of the most common causes of lower back pain and leg pain (sciatica); 80% of people experience lower back pain at one point in their lives, and this is mostly caused by lumbar hernia. With aging or when movements forcing body are executed, discs between vertebrae forming backbone may slide, and as a result, jelly-like substance inside vertebrae leaks out from ruptured part of the disc, causing lumbar hernia. This may cause back or leg pain, numbness or tingling. Therapeutic options may help recovery including resting, painkillers, spinal cord injections and physical therapy. If the problem persists, or loss of bladder or bowel function occurs, operation might be necessary.
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Lower back spine of our body consists of 5 lumbar vertebrae. There is a cartilage called disc between each 2 lumbar vertebrae. With aging or wearing, the discs lose their soft fluids, and become flatter and harder. Known as disc degeneration (damage), this process may start at younger ages.
A jelly-like tissue is present inside the disc. When the back bone is pressured the durable outer ring of the disc gets ruptured. The jelly leaks out of the rupture site, and irritates the spinal cord canal and nerve roots. This is called lumbar hernia.
The inflammation of spinal nerves and the pressure of the hernia on the nerve cause lumbar hernia pain. Sciatica is usually a lumbar hernia-related symptom. Pressure on one or more nerves supporting the sciatica nerve may cause pain, burning sensation, tingling and numbness from hip to leg, and sometimes to foot. Sneezing, coughing and bending over usually increases the pain. Usually, one side (left or right) is affected.
Though rare, the symptoms of lumbar hernia may include loss of bowel or bladder control. If this occurs, you should seek immediate medical help.
It is worse than the back pain. If the pain is spread over the long sciatic nerve track behind the leg, it is termed sciatica or radiculopathy.
One of the most striking symptoms is neuralgia seen on legs and causing burning, searing, electrocuting or stinging sensation.
Based on the location and grade of the hernia, the symptoms may be observed in lower back, calf, the front or back of the leg, hip, foot and/or toes, and typically affect one side of the body.
Numbness, needle stick sensation, weakness and/or pins and needles may be observed on leg, foot and/or toes.
The neurological symptoms caused by lumbar hernia may include difficulty in lifting up the leg when walking or standing on toes. This is also called “foot drop”.
Lower back pain may be seen, however it is not a must. Lower back pain can be defined as constant or throbbing, and you may have difficulty with bending over. If the herniated disc is causing lower back muscle spasm, one or two days of bed-rest may be necessary to alleviate the pain.
Applying ice or heat may also alleviate the pain. You should use a chair with back support when sitting, and support the lower back by lying on your back with a pillow under your knees when sleeping.
Standing up or sitting down for a long period of time, or even walking short distances may trigger your lower back pain. Laughing, sneezing or another sudden movement may increase pain.
In many individuals, positions hanging down from a chair, bending over or bending double greatly increase the leg pain.
Herniated disc pain usually develops very fast, and sometimes, there may not be an apparent movement or incident triggering the pain.
This symptom is very rare, and caused by the pressured spinal nerve roots. It is a very serious problem, requires immediate medical intervention, and the individuals suffering from this should seek immediate medical help.
Lumbar hernia symptoms usually become more severe when the hernia is affecting a large area. If the disc herniation does not affect a nerve, the pain may be mild and is limited to lower back area. In some conditions, lower back or leg pain continues for a few days and then resolves. This may suggest the onset of lumbar hernia.
To determine whether you have lumbar hernia, your physician would first want to learn your medical history. He/she performs a physical examination to help with the diagnosis, and if he/she deems necessary, he/she may request a magnetic resonance imaging (MRI) screening for confirmation.
Today, it is possible to treat lumbar hernia using different method; there are many options from physical therapy to medical therapies, from surgery to micro-surgery. The choice of treatment is based on the condition and severity of the disease. In many cases, lumbar hernia spontaneously improves slowly within days or weeks. Typically, while many of the patients do not develop symptoms, some patients experience pain during recovery period.
Preventive care should be considered as the first choice of treatment unless there is muscle weakness, walking difficulty, or loss of bladder or bowel control (cauda equina syndrome). The main objective of non-surgical therapy is to reduce pain.
Only a small proportion of lumbar hernia patients requires operation. Spinal surgery is only recommended to patients to whom non-surgical therapy was administered previously but failed.
The most common surgical procedure for herniate lumbar disc is lumbar microdiscectomy. Microdiscectomy involves the removal of the herniated part of the disc and all pieces pressing the spinal nerve. The pressure is reduced by providing a larger space for the nerve root, and recovery may start in the nerve root.
Microdiscectomy procedure is usually very successful in alleviating the leg pain caused by the herniated disc (sciatica). While it takes a few weeks or months for the nerve root to have complete recovery, the patients are usually relieved of leg pain fast and experience very little complications after the surgery.
Most patients do not require physical therapy after the surgery. After your surgeon evaluate you and confirm that your surgical incision is healed, you can start a rehabilitation exercise program.
As a simple program which you can do at home, stretching exercises for your back and legs and a 30-minute simple walking program will help you heal faster after the operation. If necessary, your surgeon may recommend you a physiotherapist.
The only risk of non-surgical therapy is the long period of time taken for symptom improvement. If you choose to undergo operation approximately 6 months later, the outcome may not be as good as if you had chosen to undergo operation before. The risk of surgical complications is extremely low. Possible complications include:
Already being a painful condition, lumbar hernia may be even more painful during pregnancy. Interestingly, this is common in pregnant women due to the expected weight gain and increasing pressure on the spine. In some cases, the women do not experience the symptoms of lumbar hernia, and may not feel the presence of it during pregnancy. However, a herniated disc may cause severe pain which may worsen with the development and weight gain of the fetus.
First of all, pregnancy rarely causes lumbar hernia. Unless the patient has a severe osteoporosis or recently experienced a traumatic injury of lower back, the possibility of lumbar hernia developed due to pregnancy is low. However, women mostly experience a generalized back pain, and pain caused by the changes of the body and around the spine.
Women who experience moderate-to-severe lumbar hernia pain during their pregnancy, staying positive and controlling the situation with the help of a specialist is important. Mild-to-moderate hernia cases are usually not problematic for the health and safety of the woman and the baby.
However, severe cases may require treatment or intervention to some extent. The patients should also be aware that lower back pain and pelvic pain is common during pregnancy, especially during the third trimester.
To experience a smooth, trouble-free pregnancy, you should stay positive and educate yourself about the herniated discs. If you are experiencing pain, you can benefit from bed-rest and preventive measures such as safe exercises to avoid more injury or pain.