A lumbar herniated disc occurs when the material inside of the disc (nucleus pulposus) protrudes out of the outer fibrous layers of the disc (annulus fibrosus). This can occur from traumatic causes like a motor vehicle accident, falling from high up, lifting heavy objects or playing contact sports. Herniated discs have also been known to occur with relatively little force in individuals with degenerated or torn discs; this may be from a sneeze or something as simple as bending over to pick up a piece of paper.
Symptoms of a lumbar herniated disc can begin with increasing low back pain that may radiate to the legs. Weakness of certain muscle groups may develop depending on which nerve roots are affected. Sensation can be decreased or altered as well. Sometimes the nerves to the bladder or bowel are affected which can result in loss of control of bladder and bowel function.
Physiatrists often are able to manage the symptoms of a herniated disc conservatively, and about 80% of patients with radiating low back pain from herniated discs recover without surgical intervention. Initial treatment includes activity modification such as avoiding heavy lifting or repeated bending. Anti-inflammatory medication is prescribed early on. Sometimes additional pain medications are needed. In physical therapy most patients feel better with extension exercises and traction.
In patients who fail to respond to more conservative measures we consider interventional spinal injections. These epidural injections are typically performed under x-ray guidance (fluoroscopy). The needle is placed at the level of the disc herniation and a steroid is injected. Selective nerve root blocks are performed in a similar manner. The steroid acts as an anti-inflammatory to decrease pain and swelling. One study demonstrated that 38% of patients with a lumbar disc herniation were improved by 1 month, 52% by 2 months, and 73% by 3 months.
If there is no improvement within three months, a surgical consultation may be recommended. However, it is important to note that hose individuals with progressive weakness or sensory loss, or who have loss of control of bowel or bladder function should have surgery right away. Surgical decompression involves removing the herniation in order to take pressure off of the nerve root. Similar results are seen with traditional discectomy and newer microdiscectomy techniques.
Following treatment, return to work or to sports is primarily determined by symptoms. A study published in the Spine Journal in 2003 found that in professional and Olympic athletes who underwent a lumbar microscopic discectomy the average return to sports was 5.2 months, with 88% achieving successful return to play at their previous level. Those who are successfully treated conservatively may return even more quickly.
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