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Do you have lower back pain? You are not alone. More than 65 million Americans have lower back pain, making them spend over $10 billion per annum. The NCBI had noted low back pain as the second most common cause, making people lose 149 million workdays every year. Among the 80 percent of people who experience lower back pain, a considerable percentage would be suffering from one or more herniated lumbar discs.
Approximately 2% of the population with herniated discs are reported in the American hospitals each year. Men are more likely than women to suffer from disc herniation. People between the ages of 30 and 50 are more likely to develop a herniated disc.
At any level in the spine, a disc herniation can occur. Why do we give lumbar disc herniation such a high priority? The lumbar spine is more prone to spinal disc herniation because it is more flexible and plays an important role in weight-bearing and balancing. The symptoms resulting from herniated lumbar discs can easily be exacerbated by sitting, standing, or moving.
What is Lumbar Disc Herniation?
To understand lumbar disc herniation, we must first understand the anatomy of the spine. As we all know, our backbone consists of 33 vertebrae piled and interlocked, one on top of the other. There are spinal discs between the vertebrae to ensure the smooth movement of the spine. The spinal cord or nerve roots run beneath it in a safe spinal cavity.
Our spinal column is made up of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and the rest of the spine’s sacrum and coccyx. The lumbar spine comprises of five lumbar vertebrae connected by intervertebral discs.
The intervertebral discs are made of the annulus fibrosus and the nucleus pulposus. The tough outer layer, known as the annulus fibrosus, is made up of various nerve fibers and is flexible. The nucleus pulposus is a soft, jelly-like substance in the center. These discs work as shock absorbers during the violent movements of the body.
When wear and tear or an impact weakens or ruptures the lumbar vertebrae, it compresses the spinal discs and damages the annulus fibrosus’s outer layer. The soft nucleus pulposus will seep through the annular tear or the lumbar disc lesion, causing a disc bulge or disc herniation. When it happens in the lumbar disc, it is known as lumbar disc herniation. Disc herniation is also called a slipped disc.
Herniated Lumbar Disc Causes
Despite the fact that our spinal discs are flexible and rubbery, they can be damaged by overuse or heavy impacts. Because the lower back is the human body’s center of gravity, over-exertion can easily harm the lumbar spine. Let’s look at the causes of disc herniation in the lower back.
- Age-related: At a younger age, our discs will be healthy and hydrated. The spinal discs dry out with age due to wear and tear, making the discs weak and brittle. This is known as disc degeneration. As a result, even minor impacts or shocks can rupture the outer layers of the annulus fibrosus, allowing the nucleus to escape.
- Work-related: People who do heavy work on a regular basis, such as lifting, pushing, or pulling weights, are more likely to develop a herniated lumbar disc. Repetitive stress in the lower back can cause the nucleus pulposus to bulge through the outer layer of the lumbar spine, potentially causing damage.
- Trauma-related: Accidents involving a vehicle, such as a rear-end collision, a T-bone collision, a head-on collision, or a slip and fall, can have severe consequences for the lower back. One or more herniated lumbar discs can be caused by a sudden and forceful impact on the lumbar spine.
- Genetics: Congenital spine abnormalities are one of the risk factors for lumbar disc herniation. Even minor injuries to the lower back can result in lumbar disc herniation.
- Obesity: When a person is overweight, the spine is unable to keep the body in balance. This imbalance will put more strain on the spine, particularly the lower back. Herniated lumbar discs occur when the lumbar spine cannot withstand the pressure.
- Smoking: Tobacco use is not only injurious to the lungs. It also reduces nutrient flow to the intravertebral discs. The discs become frangible due to nutrient deficiency.
Herniated Lumbar Disc Symptoms
Don’t assume that all disc herniations will cause discomfort. Lower back pain may or may not occur depending on the level and position of the herniation. The pain radiating to the lower region varies depending on which nerve the herniated disc compresses. Let’s check out some of the symptoms of herniated lumbar disc.
- Sciatica: Sciatica is pain that radiates from the lower back along the sciatic nerve to one or more legs. Sciatica occurs when a herniated lumbar disc compresses the nerve. Numbness and tingling in the feet and toes may also result from nerve irritation. Prolonged standing or sitting can cause sharp and tingling pain. The pain may be intermittent or constant, spreading from the lower back to the buttocks, thigh, knee, leg, feet, and toes.
- Bowel or bladder dysfunction: Bowel or bladder dysfunction can occur as a result of the herniation compressing the nerves that control bladder and bowel movements. This condition can cause urinary or fecal incontinence.
- Muscle weakness: Muscles near the affected nerves will be tender and weak, causing the patient to lose balance and stumble.
- Decreased reflex: A decreased reflex is a loss of sensation in the lower part of the body caused by a herniated lumbar disc compressing a nerve. Each and every nerve has a reflex, and when they are compressed, there will be a loss of reflex in the corresponding area.
Herniated Lumbar Disc Diagnosis
Diagnosis of disc herniation in the lower back is difficult. Lower back and leg pain can also be symptoms of various other diseases. Doctors suspect disc-related health issues when patients experience chronic lower back pain that radiates to the lower extremities. Healthcare providers typically use the diagnostic techniques listed below to confirm herniated lumbar discs.
- Physical examination: Physical examinations such as range of motion, leg raise test, gait test, and lumbar area palpation will be performed by physicians to diagnose lumbar disc herniation. To some extent, these tests will aid in the diagnosis of disc herniations.
- Neurological exams: Neurological exams are performed when lumbar radiculopathy is suspected to be the result of a disc herniation. The physicians use reflex hammers to assess the loss of reflexes in the lower extremities.
- X-rays: X-rays produce clear images of the human body’s bony structures. However, they cannot always detect problems in the spine and nerves. X-rays are primarily used to rule out other causes of lower back and leg pain, such as infection, fracture, and misalignment.
- CT and MRI scan: CT scans reveal changes in the spine by combining multiple cross-sectional x-ray images of the spine. Though CT scans can clearly show herniated lumbar discs, MRI scans can produce accurate images that show even minor herniations and pinched nerves.
- CT Myelogram: A contrast material is injected into the subarachnoid space around the spinal cord using fluoroscopy in a Myelogram. The contrast material will highlight the disc abnormalities such as a herniated lumbar disc and nerve impingement.
- Electromyography (EMG): EMG is a non-invasive study beneficial for people who are unable to undergo MRI scans. It detects herniated lumbar discs and sciatica by detecting electric signals in the muscles.
- Nerve conduction study: It measures the speed at which electric signals travel through the nerves. Any impediment to the flow of electric signals will reveal disc abnormalities.
Herniated Lumbar Disc Treatment
Home remedies can provide significant relief for minor herniated disc symptoms until you seek medical attention. Pain medications and therapies would provide relief in a matter of weeks or months.
- Home remedies to relieve herniated disc pain:
- Ice and heat therapy: To relieve pain in the lower back, apply ice packs for the first few days. After that, you can use heat packs. For the time being, this will undoubtedly relieve sciatic pain.
- Limited rest:Chronic low back pain caused by a herniated lumbar disc does not necessitate complete rest. In some ways, complete rest exacerbates the situation. Lack of movement deconditions the muscles surrounding the affected disc and increases pressure on it. Rest, rather than relieving the pain, will aggravate the symptoms. Rest for 30 minutes every now and then, then walk or move around for a while. This will help to relieve the pain.
- Non-strenuous exercise: Mild exercises that do not require bending over or lifting anything would be beneficial.
- Yoga: Yogic postures that do not strain the lower back would alleviate the pain.
- OTC medications: OTC pain relievers such as Ibuprofen, Tylenol, Acetaminophen, and Naproxen can be taken in the prescribed doses.
- Pain medications:
When over-the-counter pain relievers are ineffective, doctors will prescribe stronger NSAIDs. Muscle relaxants will be administered to treat lumbar muscle spasms. For a limited time, oral corticosteroid medications will reduce inflammation. Antidepressants are used as pain relievers because they increase the endorphin effect and provide sleep. Though opioids can effectively treat both acute and chronic pain, long-term use of opioids can lead to opioid addiction.
- Physical therapy:
Heat and cold therapies, deep massages, nerve stimulation, hydrotherapy, traction therapy, and core muscle strengthening exercises will all help to alleviate the symptoms of a herniated lumbar disc.
- Steroid injections:
When therapies and pain medications fail to provide relief, epidural injections of anti-inflammatory corticosteroids into the spinal space will be beneficial. Depending on the outcome, three or more injections will be administered within a year.
- Chiropractic therapy:
The chiropractor will analyze the condition of the lumbar spine and devise a treatment plan with the help of diagnostic studies. In flexion-distraction therapy, the chiropractor would stretch the discs to relieve pressure using a specially designed table. Even though it cannot reverse herniation, it can provide significant relief from the symptoms of a herniated disc.
- Surgery for herniated disc:
Surgery would be the only option if all of the other treatment options failed to alleviate the symptoms of a herniated lumbar disc. Depending on the extent and size of the herniation and nerve impingement, one or more of the surgeries listed below may be beneficial. An open, endoscopic, or core removal procedure may be used to decompress the nerves.
- Laminotomy vs. Laminectomy: A laminotomy removes a portion of the lamina, whereas a laminectomy removes the entire lamina. This is done to clear the way for the discectomy.
- Discectomy: Following the removal of the lamina, the surgeon removes the protruding portion of the disc that is compressing the nerve.
- Spinal fusion: After the laminectomy, the vertebrae are stabilized with a spinal fusion. Screws are used to join two or more levels of the spine.
- Artificial Disc Surgery (ADS): If the entire disc is damaged, ADS is a better option than spinal fusion.
Not all low back pains are caused by a herniated lumbar disc. However, lumbar radiculopathy should never be ignored. Seeking treatment for a herniated lumbar disc early on will save you from extensive pain and unnecessary surgery costs. Even home remedies could save you from further disc herniation exacerbation in the early stages. Be aware and save yourself from impending dangers!
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