The L3-L4 spinal motion segment is typically treated with nonsurgical methods. Tumors, infections, and/or other causes of severe nerve root compression with significant neurological deficits may be treated surgically.

Nonsurgical Treatments for L3-L4

Illustration of pill bottle on it's side with blue pills spilling out.

Prescription and over-the-counter (OTC) medication may help reduce lower back and leg pain.

Treatment of the L3-L4 motion segment usually involves one or more of the following methods:

Medication. Both over-the-counter (OTC) and prescription medications are used to treat pain stemming from L3-L4, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, tramadol, and/or corticosteroids. Before using any medication, read warning labels carefully.
See Medications for Back Pain and Neck Pain
Immobilization. Using a back brace after an acute injury, such as fracture, may help promote healing of tissues and prevent further injury.
See Using a Back Brace for Lower Back Pain Relief
Physical therapy. Exercise and physical therapy can help strengthen neck muscles, improve posture, and increase the range of motion after an L3-L4 injury. Physical therapy is usually performed under the guidance of a physical therapist and may include exercises, stretches, manual therapy, massage, and/or other treatments.
See Physical Therapy for Low Back Pain Relief
Chiropractic manipulation. Chiropractic adjustment of the lumbar spine may help relieve pain stemming from the L3-L4 motion segment.
See Chiropractic Treatments for Lower Back Pain
Injection. Spinal nerve pain from L3 may be treated with steroid injections in the epidural space or into the L3-L4 facet joint. Risks of these injection procedures include hematoma, bleeding, and/or nerve damage. Fluoroscopic (x-ray) guidance with radiopaque contrast dye is used for correct needle placement and helps to improve diagnostic accuracy and decrease procedural risks.
See Lumbar Epidural Steroid Injections for Low Back Pain and Sciatica

Self-care measures, such as using correct posture while standing, sitting, walking, lying down, and lifting items off the floor is important to maintain a normal spinal curvature, minimize stresses, and facilitate healing.

Surgical Treatments for L3-L4

Surgical fusion of the L3-L4 spinal segment may be recommended for added stability.

The goal of lumbar spine surgery is typically aimed at relieving compression of a nerve root and/or the cauda equina.

Surgical options may include:

Laminectomy. The lamina (area of bone at the back of the vertebra) is removed in order to provide more room for the cauda equina.
See Lumbar Laminectomy Surgery for Spinal Stenosis (Open Decompression)
Foraminotomy. The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving nerve compression.
Microdiscectomy. A small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
See Microdiscectomy (Microdecompression) Spine Surgery

Watch this Lumbar Microdiscectomy Surgery Video in our Video Center.

A lumbar microdiscectomy surgery is performed to remove the portion of a herniated disc that is irritating or inflaming the nerve root.

A microdiscectomy is performed through a small incision in the midline of the low back.

First, the back muscles, called erector spinae, are lifted off the bony arch, called the lamina, of the spine. Since these back muscles run vertically, they can be moved out of the way rather than cut.

The surgeon is then able to enter the spine by removing a membrane over the nerve roots. This membrane is called the ligamentum flavum.

Often, a small portion of the inside facet joint is removed both to facilitate access to the nerve root and to relieve pressure over the nerve.

The nerve root is then gently moved to the side and the disc material is removed from under the nerve root. Only the herniated portion of the disc is removed; the healthy portion of the disc is left intact.

After the piece of the disc that is irritating or inflaming the nerve root has been removed, the pressure is off the nerve immediately and it has room to heal.

A herniated disc pressing on a nerve root can cause severe leg pain. While it may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from the leg pain almost immediately after a microdiscectomy.

Facetectomy. Trimming and/or removing a part of the facet joints and/or bony overgrowths to relieve nerve root compression.
Fusion of L3-L4. Depending on the extensiveness of the surgery and the amount of bone removed, the surgical segment may be fused with the adjacent motion segment to provide stability.
See Lumbar Spinal Fusion Surgery
Lumbar artificial disc replacement. This surgery is not very common and includes a complete replacement of the lumbar intervertebral disc to relieve nerve root compression and replace it with an artificial implant.
See Lumbar Artificial Disc Replacement for Chronic Back Pain

As with any surgery, there is always a small risk of serious complications, such as infection, nerve injury, excessive bleeding, or severe allergic reaction. Before deciding to have surgery, it is important to discuss the risks and alternatives to surgery with the surgeon. It is also important to understand the possible complications if surgery is not performed.

Infographic of 5 Tips for Lumbar Pain Relief

View this 5 Tips for Lumbar Pain Relief Infographic in our Infographic Center.

Sharp, burning, or radiating pain from a herniated disc is a call for immediate pain relief, but effective pain relief methods look different for everyone. Here are 5 little-known tips for lumbar herniated disc pain.

Heat and cold therapy help relieve muscle tension and pain. Heat can loosen muscle tightness, reduce muscle spasms, increase blood flow, and improve elasticity. Cold can decrease the local tissue temperature, providing an analgesic and anti-inflammatory effect.
Physical activity releases endorphins. Staying moderately active can provide relief of pain from a lumbar herniated disc. When you exercise, the body releases endorphins, which naturally improve your mood and reduce your perception of pain.
Certain sleep positions help relieve pain. You may find comfort sleeping in a position that relieves tension in the lower back. Try using a pillow under your knees, or lie on your side with a pillow between your knees to keep your spine straight and hips balanced.
The McKenzie Method can help shift sciatica pain. The McKenzie Method is a type of physical therapy that involves a specific approach to exercise. For lumbar herniated disc pain, the goal is to shift pain away from your leg (sciatica) and centralize it more in your lower back.
Myofascial release may help reduce pain. Myofascial pain from a lumbar herniated disc can be worsened by poor posture and inactivity. Myofascial release is a form of manual therapy that has been shown to improve low back pain.

This information is not intended or implied as a substitute for medical advice, diagnosis or treatment. All content, including text, graphics, images or other information provided is intended for general information purposes only. Always consult with your physician for diagnosis or treatment.

Dr. Andrew Cole has 30 years of experience specializing in spine and joint pain management. Dr. Cole has held numerous medical appointments throughout his career, and recently served as the Executive Director of Rehabilitation & Performance Medicine Enterprise for Swedish Health Services and as Medical Director of Ambulatory Musculoskeletal Services for Swedish Medical Group.