The bones that form the spine are cushioned by jelly-like discs that keep the spine flexible and act as shock absorbers. When the disc is damaged, it may bulge (herniate) or break open (rupture). This is thereby called a herniated disc or ruptured disc. Although a herniated disc can occur in any part of the spine, most herniated discs occur in the lower (lumbar) region of the spine.
Lumbar disc herniation may be caused by:
- Normal wear and tear of the disc, which is associated with aging.
- Injury to the spine, which may cause tiny tears in the outer layer of the disc, forcing the thick gel found inside the disc to come out through the tears. This makes the disc bulge out or break open.
A herniated disc may press on adjacent nerve roots, causing pain, numbness, tingling and weakness in areas of the body served by the nerve. However, if a herniated disc does not press on a nerve, you may experience no pain or backache at all.
A lumbar disc herniation can cause pain and numbness in your buttock and leg. This common is condition is called sciatica. Impingement of the nerve at the L4 - L5 level can cause numbness and pain on top of one foot, while impingement of the nerve at the L5 - S1 level may affect the sole or outside of the foot. Weakness of the ankle and ability to use the big toe may also be affected.
Consult a doctor right away if you experience numbness or weakness in both legs, with loss of bowel or bladder control. It could be a sign of cauda equina syndrome, an uncommon but serious problem.
Symptoms of lumbar disc herniation usually get better in a few weeks and very few people (1 in 10) will need surgical treatment. Home treatments include:
- Bed rest for severe pain.
- For mild pain, walking and other light activities may help.
- Using a heating pad for 15-20 minutes every two or three hours.
- Getting a warm shower.
- Applying an ice pack on the back for 10-15 minutes every 2 to 3 hours.
- Doing physical therapy exercises to keep your back muscles strong
- Taking over-the-counter pain relievers.
- Protecting your back when lifting by using your legs, not the back. Bend the knees, and then squat. Avoid bending forward at the waist when lifting objects.
- Using good posture when standing or walking to support the lower back.
- Doing regular exercise.
- Maintaining a healthy weight to reduce the load on the lower back.
- Not smoking, which increases your risk of disc injury.
Surgical treatment for lumbar disc herniation is needed only when there is a severe loss of nerve function, causing weakness, difficulty standing/walking, and loss of bowel/bladder control. A microdiscectomy may be done to take pressure off the nerve root on an outpatient basis.
Although the success rate of this surgery is about 95%, a few patients experience a recurrence of disc herniation. If it recurs many times, lumbar fusion surgery may be done to stop motion at the level of the disc.
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