Lumbar Disk Disease (Herniated Disk)

What is lumbar disk disease?

The vertebral column, or backbone, is made up of 33 vertebrae that are separated by spongy disks. The spine is divided into 4 areas:

  • Cervical spine: The first 7 vertebrae, located in the neck
  • Thoracic spine: The next 12 vertebrae, located in the chest area
  • Lumbar spine: The next 5 vertebrae, located in the lower back
  • Sacral spine: The lowest 5 vertebrae, located below the waist, also includes the 4 vertebrae that make up the tailbone (coccyx)

The lumbar spine consists of 5 bony segments in the lower back area, which is where lumbar disk disease occurs.

  • Bulging disk. With age, the intervertebral disk may
    lose fluid and become dried out. As this happens, the spongy disk (which is located
    between the bony parts of the spine and acts as a “shock absorber”) becomes
    compressed. This may lead to the breakdown of the tough outer ring. This lets the
    nucleus, or the inside of the ring, to bulge out. This is called a bulging disk.
  • Ruptured or herniated disk. As the disk continues to break
    down, or with continued stress on the spine, the inner nucleus pulposus may actually
    rupture out from the annulus. This is a ruptured, or herniated, disk. The fragments
    of disk material can then press on the nerve roots located just behind the disk
    space. This can cause pain, weakness, numbness, or changes in sensation.

Most disk herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra (the L4-5 and L5-S1 levels).

What are the symptoms of lumbar disk disease?

The symptoms of lumbar disk disease vary depending on where the disk has herniated, and what nerve root it is pushing on. These are the most common symptoms of lumbar disk disease:

  • Intermittent or continuous back pain.
    This may be made worse by movement, coughing, sneezing, or standing for long periods
    of time.
  • Spasm of the back muscles
  • Sciatica. This is pain that starts
    near the back or buttock and travels down the leg to the calf or into the foot.
  • Muscle weakness in the legs
  • Numbness in the leg or foot
  • Decreased reflexes at the knee or ankle
  • Changes in bladder or bowel function

The symptoms of lumbar disk disease
may look like other health conditions. Always see your healthcare provider for a
diagnosis.

How is lumbar disk disease diagnosed?

In addition to a complete medical history and physical exam, you may have one or more of the following tests:

  • X-ray. A test that uses invisible electromagnetic energy
    beams to produce images of internal tissues, bones, and organs onto film.
  • MRI. A procedure that uses a combination of large magnets,
    radiofrequencies, and a computer to produce detailed images of organs and structures
    within the body.
  • Myelogram. A procedure that uses dye injected into the
    spinal canal to make the structure clearly visible on X-rays.
  • CT scan. An imaging procedure that uses X-rays and
    computer technology to make detailed images of any part of the body, including the
    bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Electromyography (EMG). A test that measures muscle
    response or electrical activity in response to a nerve’s stimulation of the
    muscle.


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How is lumbar disk disease treated?

Typically, conservative therapy is the first line of treatment to manage lumbar disk disease. This may include a mix of the following:

  • Bed rest
  • Education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)
  • Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
  • Weight control
  • Use of a lumbosacral back support
  • Medicine to control pain and relax muscles

If these measures fail, you may
need surgery to  remove the herniated disk. Surgery is done under general anesthesia.
Your surgeon will make an incision in your lower back over the area where the disk is
herniated. Some bone from the back of the spine may be removed to gain access to the
disk. Your surgeon will remove the herniated part of the disk and any extra loose pieces
from the disk space.

After surgery, you may be
restricted from activity for several weeks while you heal to prevent another disk
herniation. Your surgeon will discuss any restrictions with you.

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