Lumbar Disc Herniations- Frequently Asked Questions
Publication Date: 11/21/23
What is a lumbar herniated disc?
The spine is composed of a series of bones (vertebrae) separated by soft tissue cushions which are called discs. The discs have a soft but firm consistency with two major components. There is the “wrapper” or contained of the disc, called the annulus and there is the inner “filling” of the disc, called the nucleus pulposus.
The nucleus pulposus or “filling” is a part of the spine that provides cushion and mobility when someone is standing, moving, sitting. Sometimes, this material can herniate through an opening in the annulus. This is called a disc herniation.
There are three major areas of the spine- cervical (neck), thoracic (chest/middle area) and lumbar (lower) spine. All of these regions contain discs and a herniated disc can occur in any of these regions. If a herniated disc occurs in the lumbar region of the spine, it is called a lumbar disc herniation.
What does a lumbar herniated disc feel like?
The symptoms of a herniated disc are predominantly related to the location of the disc material. In the lumbar spine, if the disc material herniates backwards, it presses into the nerves that run to the legs and supply strength and sensation. This pressure on the nerves can be exquisitely painful in some people. It also can lead to numbness in a stripe like distribution running from the back to the legs or weakness in specific muscles (e.g. foot drop).
What are other names for a herniated disc?
Other names for a herniated disc include a slipped disc, sciatica, disc bulge or ruptured disc.
What is the difference between a disc bulge and a herniated disc?
Normally the term disc bulge is not a normal medical designation. However, when a disc has some wear and tear it can form a bump that isn’t a herniation because the inner nucleus pulposus doesn’t come through the annulus. In a herniation there is usually movement of the inner nucleus pulposus through the outer covering of the disc, the annulus, into an area where it is not normally located.
Is a herniated disc always painful?
Herniated discs are not always painful. In fact, more than 40% of people over the age of 40 may have a herniated disc that is asymptomatic.
What should I do if I think I’m experiencing a herniated disc?
The best first step is to assess your pain- its location, what positions make it worse and if there are any associated symptoms. In particular, it is important to determine if you have any weakness- for example, you can test walking on your heels and toes to check your ankles. Also, determine if you have any numbness. Next, you can contact a physician to determine the next steps. Often over the counter anti-inflammatories or pain medication can be the best first step. In rare cases, disc herniations can cause bowel or bladder incontinence, because of pressure from the disc material on nerves that control the bladder. If this happens, it is a medical emergency, and you should seek care immediately.
What causes a herniated disc?
Sometime a sudden increase in load through the spine can cause rupture of disc materials- e.g. lifting a heavy piece of furniture or a sporting injury. However, often it is unclear what causes the herniated disc and a relatively mundane activity like bending down to pick up something from the floor could trigger a herniation. Sometimes patients wake up from sleep with achy back pain that then turns into severe herniated disc pain. Unfortunately, there is not often a clear reason/cause for why a disc herniation occurs.
When should I consider surgery for a herniated disc?
Interestingly, the body often “recognizes” that a herniated disc is not in the spot it’s supposed to be and one’s own immune system will degrade the herniation over time. This can take, on average, a year to occur. Sometimes, the pain associated with a herniated disc can go away after about a month and a half of non surgical treatment including oral anti-inflammatory medications, epidurals and physical therapy. However, sometimes, the pain is so severe or there is associated weakness that cannot wait for this natural process to happen. Other times, the disc herniation material does not undergo its normal resorption. In either case, it is reasonable to accelerate the normal process by removing the disc material that is causing the symptoms directly with surgery.
What is a herniated disc surgery called?
The surgery for a herniated disc is called a microdiscectomy. This type of surgery involves a very small incision and is done by Dr. Khormaee using a microscope. Muscle is gently moved to the side to get to the disc, and a small window is created with the removal of millimeters of tissue. The part of the disc that is herniated is then removed using specialized instruments. The removal of the pressure on nerve facilitated by the removal of the disc material is what results in relief of symptoms.
What is the long term prognosis after herniated disc surgery?
This type of surgery is an extremely successful spine surgery and the vast majority of patients return to their prior or improved levels of activity with no long term issues. There is no limitations to the activities one can pursue after healing from this type of surgery, and Dr. Khormaee’s patients have returned to multiple activities including running, paddle-boarding, skiing, rock-climbing and golf.