Lumbar Disc Herniation

Definition of disc herniation
Abnormal rupture of the soft gelatinous central portion of the disc (nucleus pulposus) through the surrounding outer ring (annulus fibrosus). In about 95% of all disc herniation cases, the L4-L5 or L5-S1 disc levels are involved.

Causes of lumbar disc herniation

•     Trauma or injury to the disc
•     Disc degeneration
•     Congenital predisposition

Types of disc herniation: There are three types of disc herniation

•     Protrusion / bulge
•     Disc herniation
•     Sequestration (disc rupture)

Clinical manifestations of disc herniation

1. If the herniated disc is:
2. Not pressing on a nerve, you may have an ache in the low back or no symptoms at all.
3. Pressing on a nerve, you may have pain, numbness, or weakness in the area of your body to which the nerve travels.
4. With herniation in the lower (lumbar) back, sciatica may develop. sciatica is pain that travels through the buttock and down a leg to the ankle or foot because of pressure on the sciatic nerve. Low back pain may accompany the leg pain.
5. Leg pain caused by a herniated disc
6. Usually occurs in only one leg.
7. May start suddenly or gradually.
8. May be constant or may come and go (intermittent).
9. May get worse ("shooting pain") when sneezing, coughing, or straining to pass stools.
10. May be aggravated by sitting, prolonged standing, and bending or twisting movements.
11. May be relieved by walking, lying down, and other positions that relax the spine and decrease pressure on the damaged disc.
12. Nerve-related symptoms caused by a herniated disc include:
13. Tingling ("pins-and-needles" sensation) or numbness in one leg that can begin in the buttock or behind the knee and extend to the thigh, ankle, or foot.
14. Weakness in certain muscles in one or both legs.
15. Pain in the front of the thigh.
16. Cauda equina syndrome

Management of disc herniation

1. The medical management traditionally involves:
2. Bed rest and analgesics and anti-inflammatory drugs.
3. Muscle relaxants help in some. Transcutaneous electrical nerve stimulation (TENS) helps in about 20% of patients.
4. Physical therapy such as (exercise, relaxation, massage, and hot compressors).