A lumbar disc herniation is when the soft material of the disc is pushed out onto a nerve in the lower back. The discs are the cushions between the bone of the spine that allow for motion between the bones. They are strong early in life; however, at about age 30, they start to become brittle and the strong outer layer may develop cracks that allow the soft inner material to leak out. The pain from a disc herniation comes from the pressure and inflammation of being contacted by the herniated disc material.
The spine is made up of 24 bones, called vertebrae, which are stacked on top of one another. These bones connect to protect the spinal cord. Five of these small, stacked bones make up your lower back, called your lumbar spine.
Your spinal cord and nerves travel through the spinal canal carrying messages between your brain and muscles. The intervertebral discs between your vertebrae are flexible, flat and round discs and are about a half-inch thick. They act as shock absorbers when you walk or run.
Most often a herniated disc is related to the natural aging of your spine. Additional risk factors that put you at an increased risk of suffering from a herniated disc include: being a male, improper lifting techniques, being overweight, repetitive activities that strain your spine, frequent driving, sedentary lifestyle and smoking.
Disc herniations are often very painful. It is not uncommon for people to come to our urgent care when a herniation first happens. The pain can be a burning, stabbing or searing discomfort. The pain occurs along the nerve, so it tends to come through the buttock and hip and down the leg.
Sometimes the pain may just be in the leg, ankle or foot depending on which nerve is pinched. The herniation may also cause some amount of numbness in the leg or weakness. The weakness may involve the foot, knee or hip. The pain can be constant although sometimes it is possible to find a comfortable position by sitting or laying down.
To determine whether you have a herniated lumbar disc, your physician will ask you for a complete medical history and conduct a physical examination. A MRI can confirm the diagnosis.
Many disc herniations will heal on its own. With medications, injections and therapy, herniations tend to heal substantially in six to eight weeks. It is acceptable to monitor a disc herniation if it is only causing pain. However, if there is weakness, the herniation should be watched closely. If strength is not improving, it is often recommended that the herniation be fixed with surgery to improve the recovery of the nerve.
- Medications: The most effective medication to help the pain of a herniation is a course of oral steroids such as Prednisione and Decadron. These medications can only be taken for several days at a time. Nerve medications, like Gabapentin and Lyrica, may ease the nerve pain of a herniation. They can cause drowsiness, but this tends to improve after taking the medication for a few days. Anti-inflammatories, such as Motrin and Aleve, may be helpful. They function to reduce the inflammation on the nerve, just as steroids do, but they are not as strong as a steroid. These medications thin the blood and cannot be taken for a week prior to any injection or surgery. Pain medications such as Percocet and Norco tend to not reduce nerve pain. These medications are often prescribed as they may take the edge off the pain but most people are surprised by how little they help.
- Injections: Spinal injections can be very helpful. A spinal injection is a type of epidural that places steroid medication on the nerve where it is being pinched by the herniation. This allows for a very high concentration of medicine right where it needs to be without the side effects of taking a high dose of steroid by mouth. The medicine stays active for approximately one month. During that time the herniation can heal. It may take two or three injections over the course of several months to get a herniation to a point where it is healed.
- Physical Therapy: Therapy can help reduce the symptoms of a herniation and the correct stretches may decrease the pressure on the nerve from the disc fragment.
- Surgery: The surgeries for disc herniations are very effective for getting rid of pain. The most common procedure to correct a disc herniation is a microdiscectomy. This is a surgery where the herniated disc fragment is simply removed through a small incision. The surgery takes approximately one hour and is performed as an outpatient procedure. Surgery is a very good option for patients with severe herniations that are associated with weakness or severe pain that is not getting better with other treatments.
A disc herniation can worsen if more disc material is pushed out onto the nerve. We recommend that people avoid bending, lifting more than 15 pounds, twisting and prolonged sitting while recovering from a disc herniation. These recommendations usually continue one month beyond the time that a patient feels they have healed from their injury.
Surgeons are different in their protocols for recovery. In general, it is ok to walk several miles a day immediately following surgery. Some physicians recommend a course of physical therapy and strengthening two weeks after surgery. During this time, there are still limitations on bending, lifting and twisting. All restrictions are lifted approximately six weeks after surgery.