Lumbar Disc Herniations
A lumbar disc herniation is a common back problem having to do with discs in the lower spine. These discs serve as cushions between the bones, and if they become torn or damaged (“herniated”), they can cause pain and related symptoms in the lower back as well as long-term compression of the nerves and spinal cord. Treatment can improve your quality of life and alleviate symptoms caused by a herniated lumbar disc.
A herniated disc in the lumbar spine can be the result of a direct injury or degeneration over time (often due to aging or osteoarthritis). Symptoms can include:
- Pain in the lower back
- Stiffness in the lower back
- Burning, weakness, or numbness that carries down into the legs
- Pain and related symptoms may extend down into the buttocks or leg(s)
Treatment for a lumbar disc usually begins with a conservative approach. Depending on the effectiveness of conservative treatments, the severity of symptoms, and the patient’s unique needs, surgery may be advised.
- Physical Therapy (PT): PT is often recommended to improve mobility and reduce pain due to a herniated lumbar disc.
- Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications can decrease inflammation and pain from disc herniations. Patients undergoing physical therapy may benefit from taking anti-inflammatory medications (over-the-counter or prescription strength) to reduce pain while they work to improve mobility.
- Injections: Patients who need temporary pain relief or who cannot undergo surgery may benefit from spinal injections to relieve their symptoms.
- Back Bracing: A back brace may be worn to stabilize the back and minimize the risk of further damage to the spine. Bracing may be recommended for patients who cannot undergo surgery or for patients who are preparing for or recovering after surgery.
- Disc Replacement Surgery: Where appropriate, disc replacement surgery can replace the herniated disc with an artificial disc. This technique preserves full mobility of the spine and can alleviate symptoms.
- Minimally Invasive Spinal Fusion: Minimally invasive spinal fusion surgery can stabilize the spine by permanently fusing together two or more spinal vertebrae. This restricts some mobility of the spine but can alleviate symptoms.
- Spinal Decompression: Minimally invasive microscopic decompression of the lumbar spine may be necessary to prevent ongoing nerve damage due to compression from lumbar disc herniations.
Frequently Asked Questions
A herniated lumbar disc may be caused by an injury or by gradual degeneration over time. It can usually be recognized by the symptoms listed above: persistent pain (potentially debilitating), stiffness, burning, numbness, and/or weakness in the lower back that may extend down into the buttocks and leg(s). A diagnosis will be confirmed with a detailed history and examination, including diagnostic testing. Testing can determine precisely where the issue lies and whether other areas of the spine have been damaged as well.
The most common risks of not treating a herniated lumbar disc are persistent pain and related symptoms, which may worsen over time. Another significant concern is the long-term risk to spinal health. A herniated disc may place pressure on the nerves or spinal cord, which can eventually lead to permanent damage and even paralysis. If you believe you have a herniated disc, it is important to get evaluated by an orthopedic spine surgeon to determine how best to manage your symptoms and monitor your long-term health.
Most patients will be advised to try conservative treatment methods before considering surgery. If the herniation is degenerative, nonoperative treatments will usually be recommended as the first line of treatment. Surgical candidates include those for whom conservative treatments fail to provide sufficient relief of symptoms and for whom symptoms inhibit day-to-day function or present an increased risk of nerve damage due to spinal compression. The severity of the disc herniation and its related symptoms will determine which surgical technique may best meet your needs.
Some patients will only be candidates for spinal fusion, but for those who are candidates for either procedure, disc replacement surgery will usually be recommended. This is because disc replacement is a motion preserving surgery that allows the spine to move and bend naturally, whereas spinal fusion will limit some range of motion. Nonetheless, each procedure has its own pros and cons. Our orthopedic spine surgeon will help you understand your options and make their best recommendation for your needs.