As a disc degenerates and breaks down, the inner core can leak out through the outer portion of the disc, and this condition is known as a disc herniation or a herniated disc.
The weak spot in the outer core of the intervertebral disc is directly under the spinal nerve root, so a herniation in this area puts direct pressure on the nerve.
The nerve runs through the leg, and any type of pinched nerve in the lower spine can cause pain to radiate along the path of the nerve through the buttock and down the leg (also called sciatica or a radiculopathy, see Figure 1).
- Many terms are used to describe a herniated disc - See What's a Herniated Disc, Pinched Nerve, Bulging Disc...?
Lumbar Herniated Disc Symptoms
General symptoms typically include one or a combination of the following:
- Leg and/or foot pain (sciatica), which may occur with or without lower back pain. Typically the leg pain is worse than the lower back pain.
- Numbness, weakness and/or tingling in the leg and/or foot
- Lower back pain and/or pain in the buttock
- Loss of bladder or bowel control (rare), which may be an indication of a serious medical condition called cauda equina syndrome.
L4-L5 and L5-S1 Disc Herniation Symptoms
The vast majority of disc herniations will occur toward the bottom of the spine at L4- L5 or L5- S1 levels. In addition to typical sciatica symptoms, nerve impingement at these levels can lead to:
- L5 nerve impingement (at the L4 – L5 level) from a herniated disc can cause weakness in extending 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 buttock.
- S1 nerve impingement (at the L5 – S1 level) from a herniated disc may cause loss of the ankle reflex and/or weakness in ankle push off (patients cannot do toe rises). Numbness and pain can radiate down to the sole or outside of the foot (see Figure 2).
For more on lumbar herniated disc symptoms, see also Sciatica Symptoms
Lumbar Herniated Disc TreatmentsIn most cases, if a patient’s pain is going to get better it will start to do so within about six weeks.
While waiting to see if the symptoms will abate on their own, several non-surgical treatments can help alleviate the pain and facilitate long term healing. The most common herniated disc nonsurgical treatments include:
- Physical therapy
- Osteopathic/chiropractic manipulation (manual manipulation)
- Heat and/or ice therapy
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Oral steroids (e.g. prednisone or methyprednisolone)
- An epidural (cortisone) injection
If the pain and other symptoms continue after six weeks, and if the pain is severe, it is reasonable to consider microdiscectomy surgery as an option.
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Lumbar Herniated Disc Surgery
A microdiscectomy is designed to take the pressure off the nerve root and to provide the nerve with a better healing environment. Usually, only the small portion of the disc that is pushing against the nerve root needs to be removed, and the majority of the intervertebral disc remains intact.
Using microsurgical techniques and a small incision, a microdiscectomy can usually be done on an outpatient basis or with one overnight stay in the hospital, and most patients can return to work full duty in one to three weeks.
With an experienced surgeon, the success rate of this surgery should be about 95%.
Recurrent Disc Herniation
Unfortunately, approximately 10% of patients will experience another disc herniation at the same location. This recurrence is most likely to happen early in the postoperative period (within the first three months), although it can happen years later. Usually a recurrence can be handled with another microdiscectomy.
If it recurs multiple times, a lumbar fusion surgery to stop the motion at the disc level and remove all of the disc material may be considered.