Lumbar Disc Herniation

Lumbar disc herniation is the most common cause of low back pain and leg pain (sciatica). The lumbar inter-vertebral discs are flat and round, present between the lumbar vertebrae and act as shock absorbers when you walk or run. There is a soft, gelatinous material in the centre (nucleus pulposus), which is encased in strong elastic tissue forming a ring around it called annulus fibrosus.

Ageing, injury or trauma may cause the annulus fibrosus to tear resulting in protrusion of the nucleus pulposus. This may compress the spinal nerves and/or spinal canal. The bulging disc may even break open releasing the gelatinous material, which is a chemical irritant, causing inflammation of the spinal nerves.

Obesity, sedentary lifestyle and smoking increase the risk of lumbar disc herniation.

What are the symptoms of disc herniation?

The symptoms of lumbar disc herniation include:

  • Mild to intense back pain, making it difficult to bend
  • Numbness and weakness in the leg or foot leading to the sensation of tingling (pins and needles)
  • Leg and/or feet pain making it difficult to walk or stand
  • In rare cases, loss of bowel and bladder function (cauda equine syndrome) may occur. This condition requires immediate medical attention.

How is disc herniation diagnosed?

Diagnosis includes medical history coupled with physical and neurological examination. Neurological examination is done to indicate any neurological injury and involves evaluation of reflexes and muscle weakness by various tests. To confirm the diagnosis, the doctor may order a MRI to evaluate changes in the disc and spinal nerves.

What are the treatment options?

Non-surgical treatment

Non-surgical treatment is preferred over surgery and includes rest, activity modification, and pain medication which includes non-steroidal anti-inflammatory drugs, muscle relaxants and epidural analgesic injections. Back braces are recommended for a few days to keep the lower back still and reduce mechanical pain due to movement. Physical therapy or acupuncture may be helpful in some cases.

Surgery

Surgery is considered in cases with significant leg pain, muscle weakness and numbness that is unresolved after conservative treatment measures. Urgent surgery may be required if neurologic dysfunction or cauda equine syndrome occurs.

Microdiscetomy is the most commonly used surgical procedure for lumbar disc herniation. It involves removal of part of the herniated disc causing nerve compression. It is a comparatively safe procedure but some of the risks include infection, nerve damage, dural leak, or hematoma. Most patients undergoing surgery find significant respite in pain after the surgery.

Talk to your surgeon about any concerns you have about this surgery.

  • Ashford and St Peter’s Hospital

    NHS

    Ashford and St Peter’s
    Hospital
    NHS Foundation Trust
    Guildford Road, Cherstey,
    Surrey, KY16 0PZ.
    Ph: 01932 872 000
  • The BMI Runnymede Hospital

    Private

    The BMI
    Runnymede Hospital
    Guildford Road,
    Ottershaw, CHERTSEY,
    KT16 0RQ.
    Ph: 01932 877800
  • Spire St Anthony’s Hospital

    Private

    Spire St Anthony’s
    Hospital
    801 London Road,
    NORTH CHEAM,
    SM3 9DW.
    Ph: 020 8337 6691
  • Nuffield Health Woking Hospital

    Private

    Nuffield Health
    Woking Hospital
    Shores Road,
    WOKING,
    GU21 4BY.
    Ph: 01483 331257
  • Ramsay Health Ashtead Hospital

    Private

    Ramsay Health
    Ashtead Hospital
    The Warren,
    Ashtead, Surrey.
    KT21 2SB.
    Ph: 01372 221400