Herniated Disc In Lower Back

Alternative names: Herniated Lumbar Disc, Slipped Lumbar Disc, Ruptured Lumbar Disc, Herniated Disc In Lower Back, Herniated Lumbar Intervertebral Disc.

A herniated disc in the spine is one in which the outer fluid has leaked out through a tear in the tough outer wall.  When this occurs in the upper spine, it is called a Herniated Cervical Disc; when it occurs in the lower spine, it is called a Herniated Lumbar Disc.

Incidence; Causes and Development

Due to the increased stresses placed upon the lower spine, Herniated Lumbar Discs are 15 times more common than Herniated Cervical Discs.  Herniation is rare (but possible) in the upper-to-middle back (thoracic) area.

Herniated discs are most common in those aged 30-50, but can occur in older people if they are involved in activity that puts excessive strain on the spine.  About three-quarters of people experience low back pain at some point in their lives.  Men are more often affected than women.

Disc bulging or herniation can occur for no obvious reason, or for reasons such as:

• Injury
• Improper lifting and/or lifting too much weight
• Excessive body weight that puts too much pressure on the lower spine

• Aging

  • Spinal discs dry out (lose water content) and become harder as we age; their tough outer walls can weaken and tear, leaving them unable to contain the gel-like nucleus inside
  • Wear and tear of the disc from repeated movement over time
• Genetics
• Smoking
• Sedentary lifestyle.  Regular exercise is important for preventing many medical conditions, including herniated discs.
• Smoking.  There is evidence that smoking reduces the oxygen supply to the discs and causes more rapid degeneration.

Various occupational or recreational activities that put excess stresses on the spine can lead to early disc degeneration.  Problems often begin when lifting objects without bending at the knee, or twisting while lifting a heavy item.

Signs and Symptoms

The leaking material from within a herniated disc can touch or compress a nerve.  When this occurs in the lower back, the resulting symptoms can include:

• Low back pain, radiating down one or both legs, and sometimes into the feet (Sciatica)
• Numbness and/or tingling in the region of the body supplied by the affected nerve(s) – generally the leg(s) or foot/feet
• Severe 'electric shock' sensations that occur whether one is standing, walking, or sitting
• Pain that increases when bending, lifting, twisting, and sitting down or standing up
• Cramping or muscle spasms in the back and/or leg
• Weakness in the muscles being supplied by the affected nerve – leg muscles are often affected, causing stumbling when walking
• Loss of reflex in the knee(s) or ankle(s)

In severe cases, symptoms of a serious problem can include:

• foot drop (a foot flops uncontrollably when walking)
• extreme leg weakness that prevents normal activities
• loss of bowel or bladder control
• paralysis
• numbness around the inner thighs, back of legs, and rectum that keeps getting worse
• sexual dysfunction

If you experience any of these serious symptoms, seek medical help immediately.  Emergency surgery is often the only option in such cases.

Diagnosis and Tests

A doctor will usually begin with discussing the patient's medical history.  Patients with herniated discs can often recall a specific incident when their spine was under stress and there was a 'pop'.

During a physical exam, the doctor will test reflexes, muscle strength, range-of-motion, walking ability, and sensitivity to touch, as well as look for tender areas in the back.

Although X-rays alone cannot show herniated discs, other imaging techniques can identify precisely the affected discs and nerves.  These techniques include MRI, CT scans, discogram, electromyography, and myelogram.

Treatment and Prevention

Lying flat on one's back with knees bent is often useful for reducing the pain because it relieves the pressure on the herniated disc.

Initial treatment includes a combination of:

• Bed rest of 1-2 days
• Over-the-counter (OTC) NSAIDs for mild to moderate pain and inflammation (ibuprofen, naproxen, aspirin, celecoxib)
• Narcotics such as codeine for more severe pain
• Nerve pain medication for damaged nerves
• Steroids, orally, to reduce the swelling and inflammation of the nerves
• Spinal injections of cortisone to reduce inflammation and pain
• Epidural injections of steroids, anesthetics, and anti-inflammatories to reduce pain and swelling around spinal nerve roots
• Muscle relaxants if muscle spasms are present
• Physical therapy: ice-heat therapy, ultrasound, traction, temporary bracing, electrotherapy

If symptoms do not resolve (for 80% of people they do, within 6 weeks), then surgery is an option.  This may involve removing the herniated portion of the disc, removing the disc completely, or replacing the disc with an artificial disc.

Prevention

Ways to reduce your risk of developing herniated discs include:

• Proper lifting techniques ("life with the knees, not your back!")
• Proper posture when sitting, standing, moving, and sleeping
• Exercise to strengthen weak abdominal muscles
• A comfortable and efficient working environment
• Maintaining a healthy weight
• Stopping smoking

Prognosis; Complications; Seek medical attention if...

Over time, a herniation tends to shrink and there may be partial or complete pain relief.  If the pain is going to resolve by itself, it usually does so within 6 weeks.

In severe cases, a small piece of the herniated disc can become detached and lodge in the spinal canal.

Seek medical attention immediately if you experience severe symptoms such as loss of bowel or bladder control (incontinence).