The spine is comprised of bony vertebrae separated by intervertebral discs. The lumbar spine consists of five vertebrae numbered L1 to L5. These vertebrae are attached to the tail bone (sacrum) at the lower end of the spine. The spinal cord runs within the vertebrae. The intervertebral discs act as a cushion and absorb shock. The disc is made of an inner soft gelatinous tissue and an outer thick strong layer.
Different conditions of the lumbar spine, including disc herniation are a major cause of low back pain.
Herniation is the protrusion of an organ beyond the cavity containing it. Such conditions can also occur in the spine, known as disc herniation. When the outer thick layer of the intervertebral disc degenerates, the inner soft tissue ruptures or bulges out. This bulging of the disc is called as a herniated disc. When this bulging disc irritates the nerves close by to it and produce pain, numbness, and weakness of the legs or arms.
You may be having a herniated disc and not producing any pain at all, and will be diagnosed accidentally. However, it can produce very severe pain for some people. Although herniation can occur in the cervical vertebrae in the neck, herniation of discs is more common in the lower back (Lumbar spine).
The common signs and symptoms of a herniated disc include:
- Back pain radiating to your legs or arms – If you have a disc herniation in your lower back, it will produce intense pain in the buttocks, thighs and the calf. The pain mare increase in its severity during coughing, sneezing and movement.
- Numbness – Patients often develop numbness in the area supplied by the irritated nerve by the herniated disc.
- Weakness – The irritated nerve will cause weakness of the muscles it supplies to.
If you develop lower back pain following a trauma or if it’s associated with symptoms such as fever with chills, weight loss over a short period of time, weakness of the legs, severe abdominal pain and sudden bowel or bladder incontinence, visit a doctor as soon as you can.
What causes disc herniation?
Disc herniation is most often due to age related causes. As you age, the intervertebral dis loses water and its tendency to rupture increases even with a minor strain or twist.
Lifting heavy weights can also cause herniation of the disc and rarely traumatic events can lead to disc herniation.
Who is at risk?
People doing jobs which require repeated lifting of heavy weights, pulling and pushing heavy objects are at a higher risk of developing disc herniation. Obesity also causes excessive stress on the intervertebral discs and puts them at a high risk of disc herniation. Some are genetically predisposed to disc herniation.
How is disc herniation managed?
- Pain medications – If you have a mild to moderate pain, then your doctor will prescribe you simple analgesics such as ibuprofen. However, if your pain is very severe or if it does not increase with simple analgesics, your doctor will prescribe you narcotics such as codeine.
- Muscle relaxants – Medications which relaxes your muscles will be prescribed to you if you have associated muscle spasms.
- Cortisone injections – These may be given to reduce the inflammation in and around your spinal nerves. These injections are given with the guide of spinal imaging.
- Physiotherapy – This is the most important part in the management of disc herniation. You will be referred to a physiotherapist by your doctor. These physiotherapy exercises will help to relieve the pain.
Most cases of disc herniation get better spontaneously without any treatment or surgery. If the back pain does not reduce with medications even after 6 weeks, then surgery is recommended in these patients. Only a minority of the patients will require surgery. During surgery, a protruding disc will be removed and the vertebrae will be fused together with some metal hardware to provide stability to the spine.