Lumbar Disc Disease
What Is It?
Lumbar disc disease is disease of the intervertebral discs of the spine in the lower back, the lumbar spine. The most common form of disc disease is a herniated disc, and a lumbar herniated disc is one of the most common locations for these herniations. A cervical herniated disc
is another common site for disc herniation.
The intervertebral disc is a unique type of cartilage which connects the spinal bones and acts as a form of cushion for weight-bearing and movement of the spine. With degenerative aging processes the disc can start to fail, leading sometimes to pain, and eventually can rupture. Rupture results from a tearing of the outer, fibrous ring of the disc, allowing the soft internal parts to herniate out through the opening. This often occurs at a location which leads to the disc pressing on a spinal nerve adjacent to the spine which can cause the symptoms in the leg that are typical.
Less commonly, a herniated lumbar disc can occur from acute trauma to the spine, such as a fall.
What Types of Symptoms Are Typical?
One of the common symptoms of lumbar disc disease is pain. Pain can occur in the back, but as the disc herniates and compresses nerves it can cause pain which radiates into the leg. While this pain in the leg can vary, it is very common to present with pain that shoots down the back of the leg, often worsened by certain movements, often termed sciatica.
As the nerves to the leg get compressed by the lumbar herniated disc, it can lead to other neurological symptoms, including muscle weakness, numbness and/or tingling in the distribution of that nerve. If only one level is affected, this generally involves only one leg in a particular distribution of muscles and skin which are normally supplied by that nerve. This is because the disc most commonly herniates to one side or the other, not both. In the case of multiple herniated discs, both legs and different parts of the leg can be involved. Rarely, if a disc herniation is central, rather than the more common lateral herniation, one disc can affect both legs at once.
If a herniated disc has been present for a long time, muscle weakness can eventually lead to atrophy of the involved muscles and/or complete numbness of the area of skin supplied by the nerve.
How Is The Diagnosis Typically Made?
Back pain can be caused by many different things. A herniated disc is just one of them. However, most people who are diagnosed with lumbar disc disease have additional symptoms, including leg pain, numbness, tingling and/or muscle weakness. This typical presentation makes the diagnoses much more likely than if a patient only has back pain.
After a neurological evaluation, including a straight leg raise test to see if the pain in the leg can be reproduced, imaging studies such as a CT scan or MRI scan may be done. MRI is very effective at demonstrating a herniated disc and can even show the nerve root which is compressed by the disc. The MRI can also reveal other spinal disease problems which may co-exist with the disc disease.
If there is a question of whether the disc is responsible for the patient's symptoms, occasionally tests such as a nerve conduction study may be performed to evaluate the function of the nerves.
What Are Some Common Treatments?
Treatment for lumbar disc disease varies considerably from patient to patient depending on many factors. However, many patients who initially present with this disease will be recommended to undergo a trial of rest and anti-inflammatory pain killers and later physical therapy. In many cases, this conservative treatment will lead to resolution of the symptoms.
Other treatments may include injections that help decrease the inflammation.
If these more conservative measures fail to control symptoms, or if the symptoms are very severe, some patients will undergo a surgical procedure. The most common surgery is called a discectomy, which is surgical removal of the herniated disc. The aim is to remove the herniated tissue so that the nerve is not irritated by it anymore. In many patients this is effective and reversing or lessening their symptoms. Traditionally a discectomy is done through a small incision with the surgical microscope and is termed a microdiscectomy. More recently, some surgeons have begun using metal tubes to expose the spine with an endoscope or microscope for visualization. This is often termed minimally invasive spine surgery or endoscopic disc surgery. However, for lumbar disc disease, it has not yet been proven which is more effective or is better tolerated by the patient. In general, in an appropriate patient, both procedures are very effective, regardless of the specific technique.
In more complex cases, a more involved procedure may be required, such as a spinal fusion.
Because each patient is different, treatment suggestions and decisions should be made with their own treating physician.
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This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.