Lumbar herniated disc
How a herniated disc causes pain
As a disc
degenerates, it can herniate (the inner core extrudes)
back into the spinal canal, which is known as a disc
herniation (or a herniated disc). The weak spot in a disc is directly under
the nerve root, and a herniated disc in this area puts
direct pressure on the nerve, which in turn can cause
pain to radiate all the way down the patient’s
leg to the foot (see Figure
1).
Approximately 90% of disc herniations will occur at
L4- L5 (lumbar segments 4 and 5) or L5- S1 (lumbar
segment 5 and sacral segment1), which causes
pain in the L5 nerve or S1 nerve, respectively.
-
L5 nerve impingement from a herniated disc
can cause weakness in extension of the big toe and
potentially in the ankle (foot drop). Numbness and
pain can be felt on top of the foot, and the pain
may also radiate into the rear.
-
S1 nerve impingement from a herniated disc
may cause loss of the ankle reflex and/or weakness
in ankle push off (e.g. patients cannot do toe rises).
Numbness and pain can radiate down to the sole or
outside of the foot (see Figure
2).
Conservative treatment for a lumbar herniated
disc
In most cases, if a patient’s low back and/or
leg pain is going to resolve after a lumbar herniated
disc it will do so within about six weeks. While waiting
to see if the disc will heal on its own, several conservative
treatment options can help reduce the back pain, leg
pain and discomfort caused by the herniated disc.
-
Physical therapy
-
Osteopathic/chiropractic manipulations
-
Non-steroidal anti-inflammatory drugs (NSAIDs)
-
Oral steroids (e.g. prednisone or methyprednisolone)
-
An epidural (cortisone) injection
If the pain continues after six weeks, it is reasonable
to consider microdiscectomy surgery as an option to
alleviate the pain from the herniated disc. A microdiscectomy
essentially acts as a microdecompression of the nerve
root to provide the nerve with a better healing environment.
Surgical treatment for a lumbar herniated disc
Using microsurgical techniques (a small operation using a microscope) to treat
a lumbar herniated disc, a microdiscectomy can usually be done on an outpatient
basis or with an overnight stay in the hospital, and most patients can return
to work full duty in one to three weeks. For more information on this procedure, please see Microdiscectomy (microdecompression) back surgery.
With an experienced surgeon, the success rate of surgery
for a lumbar herniated disc should be about 95%. Usually,
only the small portion of the disc (5-8%) that is pushing
against the nerve root needs to be excised, and the
majority of the disc remains intact.
By: Peter
F. Ullrich, Jr., MD
September 8, 1999
Updated March 15, 2001
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