Lumbar Disc Herniation

Beginning at the age of twenty, we begin to develop “cracks” in a protective layer around our lumbar discs. It is through these cracks that a portion of the disc may extrude or “herniate” causing symptoms in the legs. Such a lumbar disc herniation, commonly known as a “slipped disc” in the lower back, can cause various symptoms depending on the location and severity of the disc protrusion. The most common signs and symptoms include:

• Lower back pain: This is often the first symptom experienced, ranging from a dull ache to severe, sharp pain.
  
• Leg pain (sciatica): The herniated disc can put pressure on one of the nerves in the lumbar spine causing pain that radiates down the buttocks, thighs, and legs, sometimes accompanied by numbness or tingling.
• Muscle weakness: The compressed nerve may cause weakness in the leg muscles, making it difficult to walk or stand. A common form of this is a ”drop foot’ ” in which the muscles that raise the foot off the ground become weakened.
• Numbness or tingling: Numbness or a pins-and-needles sensation in the legs or feet can occur due to nerve compression.  

Management of a lumbar disc herniation typically begins with non-surgical treatments, since the vast majority of lumbar disc herniations do not require surgery. These measures include:

• Rest and activity modification: Limiting strenuous activities and taking short periods of rest can help relieve pain.
• Pain medication: Over-the-counter anti-inflammatory drugs like ibuprofen or prescription medications may be recommended to reduce inflammation and pain
• Physical therapy: Specific exercises can help strengthen the back and abdominal muscles, improving support for the spine.
• Epidural steroid injections: Injections of corticosteroids near the affected nerve can provide temporary pain relief by reducing inflammation.

Surgery is generally considered if non-surgical treatments fail to provide relief after several weeks or if there are severe or progressive neurological symptoms, such as:

• Worsening muscle weakness or numbness.
• Loss of bladder or bowel control (cauda equina syndrome, a medical emergency).
  

Surgical options include discectomy (removing a portion of the herniated disc). This is a relatively minor procedure, and patients may elect to go home the same day. The goal of surgery is to relieve pressure on the affected nerve and alleviate symptoms, and the procedure can help restore lost strength and sensation if performed in a timely fashion.