Lumbar Herniated Disc

The other name of lumbar herniated disc is lumbar disc herniation. In parallel with the technological advancements, inactive lifestyle of people is one of the most important reasons for the increased number of patients with low back pain. Lumber disc hernia is one of the most common diseases, which causes labour loss.  The region called low back is composed of five vertebrae called lumbar and each of these receives a number from L1 to L5.  Studies have shown that 80% of people complain about low back pain at any stage of their lives.  Herniated lumbar disc is the most common cause of back pains.

Most of the body's weight is carried by lumbar vertebrae.  Therefore, hernia is more common in the low back region.  It is between L4-5 and L5-S1 of the lumbar region in 95% of patients.  Since 90% of patients' pain complaints heal within a month without any treatment, many patients do not visit a physician.  Patients with low back pain have a 5% risk of having herniated lumbar disc throughout their lives.

Risk factors for developing herniated lumbar disc include young-middle age, male gender, genetic predisposition, environmental factors, previous trauma and smoking.  As a result of increased prevalence of low back pain with advancing age, the incidence rate of herniated lumbar disc increases. The reason is the loss of liquid found in the structure of the disc and hardening.  Environmental factors can be summarized as excessive mechanical force, sedentary lifestyle, exposure to repetitive vibrational effects.

The most common complaint of herniated lumbar disc is the pain.  Patients with herniated lumbar disc suffer from low back pain that arises suddenly or spontaneously step by step as a result of a reverse movement or trauma.  This pain that restricts the low back movements of a person regresses spontaneously or with bed rest and medical treatment within 2-3 weeks.  In rare cases, it may show up in the form of direct low back and leg pain.  Leg pain is added to the nonhealing low back pain.  Many patients describe the leg pain in the sensory distribution region of the nerve root that is under compression.  The pain worsens when moving, coughing, sneezing, straining and reduces by bed rest.

The second finding that accompanies the pain is often the numbness in the legs.  The numbness is localized in the region where the compressed nerve is functioning.  Loss of strength is a less common complaint.  Loss of reflexes also show up in later stages of herniated lumbar disc.

Magnetic resonance (MR) imaging is the most commonly preferred technique amongst the diagnostic techniques.  Lumbar CT can be preferred for claustrophobic patients and for patients who are considered to have an osseous pathology.  Direct x-ray imaging is used in cases in which slipped disc and fracture are suspected.

Treatment methods for herniated lumbar discs can be divided into two:

1- Conservative treatment
2- Surgical treatment

In the natural course of the pain associated with the lumbar herniated disc, the pain disappears within a few months in most of patient.  This reveals the need of conservative treatment as first-line treatment.  Conservative treatment should be at least 6 weeks and maximum 6 months.  During this treatment period, short bed rest, administrations of pain reliever and muscle relaxant should be carried out and afterwards firstly passive movements and then exercise programs should be performed gradually.

The other method frequently used by patients with low back pain is to use corsets.  However, since it causes muscle weakness, the use of corset is not recommended nowadays.

Surgical treatment should be considered if a patient is suffering from progressive loss of strength, does not benefit from conservative treatment, has repetitive pain and repetitive neurological deficit and hernia with lumbar spinal stenosis, or if it further affects the quality of patient's social life.  If a patient has any finding such as urinary or fecal incontinence, foot drop (inability or impaired ability to raise the toes or raise the foot from the ankle), surgical treatment should be performed within 24 hours.

Surgical techniques are;

Standard lumbar discectomy
Lumbar microdiscectomy
Arthroscopic microdiscectomy.

Sources

Turkish Neurosurgical Society Publications, Basic Neurosurgery Book