The bones that form your spine (vertebrae) are cushioned by spongy discs that act as shock absorbers. They also keep your spine flexible. When these discs are damaged, they may bulge (herniate) or break open. This condition is called a herniated disc, slipped disc or ruptured disc. It is a common cause of lower back pain and leg pain and leads to dull or sharp pains, muscle cramping, and leg weakness. The pain is intensified by bending, sneezing, or coughing.
Another common symptom is sciatica, which is caused by pressure on the nerves that form the sciatic nerve. This is associated with one-sided pain, burning, numbness, and tingling that radiates from your buttock into the leg and even into the foot.
Conservative treatment involves avoiding painful positions and following an exercise and pain-relief regimen that usually relieves symptoms.
Medications include over-the-counter analgesics such as ibuprofen (Advil) or naproxen (Aleve), prescribed narcotics such as codeine and nerve pain medications such as gabapentin (Neurontin), pregabalin (Lyrica), and tramadol (Ultram). Some doctors may also recommend local cortisone injections to reduce inflammation and swelling. Physical therapy consists of heat or ice application, traction, electrical stimulation, ultrasound, and back braces.
Some people may need lumbar decompression surgery for a herniated disc, especially those who continue to experience severe symptoms after conservative treatment for at least six weeks. These symptoms include numbness and weakness of the leg, trouble standing and walking, and loss of bowel or bladder control. Surgery may involve the removal of the protruding part of the disc, or removal of the entire disk. In some cases, the vertebrae have to be fused together using metal hardware for spinal stability. There are various surgical options, including minimally invasive techniques that result in smaller incisions, fewer complications, shorter hospital stay, and faster recovery.
Recovery After Lumbar Spine Surgery
Many patients are able to gradually return to work and resume daily activities a few weeks after surgery with the help of rehabilitation programs that may include home exercises and physical therapy.
Unfortunately, one in ten patients may experience a recurrence of their problem within the first three months after their surgery. Some may have another disc herniation on the same location. Recurrence of symptoms may also happen some years later. If symptoms recur frequently, your doctor may recommend fusing the vertebrae (lumbar fusion surgery) to stop any motion at the level of the disc. Removal of disk material may also be considered.
After decompression surgery, it may take rather a while for the nerve root to recover. However, if your symptoms get better within three months after the surgery, you should continue to improve. If there is no improvement in pain after three months, then further work up may be necessary. In some patients the pain becomes even worse for a while after surgery because of the swelling around the nerve root.
It may take longer for symptoms like numbness, tingling and weakness to improve, sometimes up to one year. If symptoms persist after one year, permanent nerve damage may have occurred and is unlikely to improve.
Symptoms may also come back years after spinal decompression because of a recurrence of the herniation or another disc has herniated.
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