The spinal column is made up of spinal bones, called vertebrae, which stack on top of each other. Each vertebra is separated by an intervertebral disc. These intervertebral discs work as shock absorbers. They are made up of a tough fibrous outer layer (annulus fibrosus) and a gelatinous inner core (nucleus pulposus). When the fibrous outer layer of the disc tears (annular tear), the gelatinous inner core can bulge out (herniate); this is a disc herniation.
A herniated disc is also referred to as bulging disc, slipped disc, disc prolapse, torn disc, disc protrusion and ruptured disc. There is not one single correct phrase.
Annular tears and disc herniations can cause severe pain. Some disc herniations cause compression of the nearby spinal cord or spinal nerves. This can result in severe pain, numbness, weakness or bladder or bowel disturbance and may require urgent medical attention.
Symptoms typically vary depending on the position of the disc and the size of the herniation.
Symptoms of a disc herniation in the lumbar region of the spine (lower back) may include:
If you have pain in both legs or weakness in your legs or feet, numbness in your buttocks or perineum (groin), or a change in bladder and bowel function you should seek immediate medical attention.
A disc herniation may be caused by a variety of reasons. Age is usually a factor. A healthy disc is well hydrated and the outer layer securely encases the inner gel. As discs get older and degenerate they become less hydrated, flatter and the outer layer can become more brittle. This means that it is more likely to let some of the inner gel leak out (herniate). Poor posture, awkward bending or heavy lifting in an awkward position can exert extra pressure on the discs.
Other factors may also increase the risk of developing a prolapsed disc which include lack of exercise; a job that involves a lot of lifting or sitting; weight bearing and axial loading occupations, sports and other recreational activities; obesity, smoking or genetic factors.
An MRI (magnetic resonance imaging) typically produces detailed images of bones (vertebrae), discs (intervertebral discs) and nerves in the lumbar region and allows for exact diagnosis. Sometimes additional diagnostic investigation is required such as SPECT-CT bone scan, EOS scan, flexion/extension X-ray or nerve conduction studies and electromyography (electrical studies). Occasionally, CT-guided nerve injections can be used for both diagnosis and treatment.
Conservative (non-operative) treatment options will usually be considered initially and will aim to reduce pain and associated symptoms and can include:
If symptoms have not improved with conservative treatment or are very severe (or if there is motor deficit such as weakness or numbness) then surgery may be considered.
Surgery involves removing the abnormal part of spinal disc which is pressing on the lumbar nerve root or roots. This is known as lumbar decompression. The most common lumbar decompression operations are microdiscectomy and laminectomy.
Lumbar Disc Herniation Specialist
Dr Laban is a specialist spine surgeon and sees patients with all types of back pain related problems and conditions. Even though back pain is common, there can be underlying issues that you may not be aware of. If your back pain and related symptoms are getting in the way of life and not resolving themselves then it is important to get an expert opinion. Contact us to book an appointment and get the diagnosis and help you need.