Herniated lumbar intervertebral disc - information, diagnosis and treatment options
A lumbar disc herniation can cause an acute onset of back pain that travels down the leg and is accompanied by numbness and even paralysis. A timely diagnosis and appropriate treatment are important to avoid permanent nerve damage.
What is a lumbar intervertebral disc and what are its functions?
The lumbar intervertebral discs are located between the five lumbar vertebrae. Since the lumbar spine is very mobile, the disc has to withstand the everyday pulls and pressures, and shearing forces. It does this through a unique fibrous ring that surrounds the nucleus pulposus (NP). The in this ring arranged connective tissue fibers are intertwined in such a way that with every imaginable movement, part of the fibers relaxes, thus preventing excessive movement. The gelatinous nucleus of the disc is made up largely of protein molecules that can store water excellently. In this way, the intervertebral discs act as a cushion filled with water. It functions as a buffer between the bony vertebrae that reliably absorbs all and distribute all stresses and strains even
What causes a herniated lumbar intervertebral disc?
The trigger for a herniated disc is often heavy lifting or a jerky motion. The lumbar herniated disc is a typical disease of middle age since two conditions must be met:
First, wear and tear, meaning small cuts, must have already occurred in the outer fibrous ring of the disc for any part of the gelatinous core to be pressed through the rupture caused by the small tears into the spinal canal. To have a herniated disk before the age of 20 years of age is extremely rare.
Second, the disc must still have sufficient swelling pressure so it can actually spill through these rupture. This again is in the majority of persons over the age of 70 years not the case
The segments most affected are the lowest motion segments of the spine: a) The segment between the fourth and fifth lumbar (L4 / 5 ) and b) the segment between the fifth lumbar and the first sacral vertebrae of the promontory ( L5/S1 ). These two discs are most strained by physical work and sports.
What are the symptoms of a herniated disc?
The symptoms of a herniated disc vary considerably and are determined by its localization in the spinal canal. Centrally leaking disc tissue, may cause local back pain, which usually increases in forward bending posture of the trunk. Intervertebral disc tissue that comes to rest with a side emphasis in the spinal canal can press against the outgoing nerve root at that place and cause pain, numbness, and even paralysis in the legs.
In most cases, the symptoms are mild with pain and / or numbness the size of a certain sensitive area of skin that is nourished sensibly by the nerve root. Paralysis are rare and are indicative of either a very unfavorably located very large herniated disc.
A so-called "mass incident" is able to almost completely fill the vertebral canal . In this case, mixed symptoms of paralysis, numbness, and pain occur in one or both legs and it comes to a loss of control of the bladder and bowel functions. This clinical picture represents a neuro-orthopedic emergency.
How is a lumbar herniated disc diagnosed?
A spine specialist can reliable predict the location of a herniated disc after having performed an accurate neuro-orthopedic examination However, since the symptoms caused by a herniated disc can differ greatly in severity a radiological imaging is necessary if a herniated disc is suspected. Since the disc is not a radiopaque structure, a disc herniation cannot be seen in a normal X-ray image. Nowadays, a herniated disc is diagnosed by magnetic resonance imaging of the lumbar spine. This allows a detailed view of the intervertebral disc and the adjacent neural structures.
What treatments are available for a lumbar herniated disc?
The prognoses for a lumbar herniated disk is good. It is known that herniated disks grow smaller over time and can indeed totally disappear. Approximately 80 – 90% of all herniated disk cases can be treated conservatively, meaning without surgery. Pain can be alleviated with physical therapy. Patients will be trained in specific exercises that they can also perform at home. Pain and accompanying inflammation of the by the herniated disk aggravated nerve root can be treated with pain relieving medication. , Parallel to the pain and exercise treatment the herniated disk is treated with a targeted infiltrations under fluoroscopic control, e.g. directly< at the affected nerve rood or the spinal canal. The injections include pain reducers and a medication that locally reduces the inflammation at the nerve root and thereby effectively controls the pain.
Surgery is only necessary if a severe paralysis is present, and here time is a decisive prognostic factor. The longer the pressure lasts on the root the less the chances that the root recovers and the paralysis recedes. This kind of neuro-orthopedic emergencies should be operated on immediately.
If the pain cannot be controlled with a conservative treatment within 6 – 8 weeks to the extent that it is acceptable, surgery is also indicated. Each surgical treatment is individually plant and will be explained to you in detail.
What are the procedures in a herniated disk surgery?
In the intervertebral disc surgery, the surgeon removes the herniated portion of the disc in the spinal canal. In the KLINIK am Ring, the removal of the herniated disk is performed in a microsurgical treatment via a minimally invasive approach under the operating microscope. The surgery is performed via an approx. 2.5 cm skin incision and takes about 30 minutes.
Since using a surgical microscope and minimally invasive surgical techniques, the physical limitations of the patient as a result of the surgery are minimal. In most cases a hospital stay of three nights is, however, necessary.
Post-surgical treatment includes mobilizing the patient as early as on the day of surgery. Simultaneously the patient will be instructed to learn techniques that will help to significantly relieve the back in during everyday activities. Sitting is possible immediately after the surgery. If needed, the surgeon will prescribe a light support belt, which relieves the facet joints from excessive pressure for about six weeks. No later than six weeks after the surgery, the patient is able to return to a normal (working) life. At this time, sports like swimming and cycling are possible again. Sports that strain the spine intensively should not be resumed until three months after the surgery.