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OAS Health Blog


Treatment of Lumbar Spine Disc herniations

November 22, 2013

I am often asked what the difference between a lumbar disk herniation, disk protrusion, and bulging disk is. There is a common misconception that these are entirely different problems.

A good analogy for a lumbar disk is a jelly donut with the jelly escaping through a hole and pushing on a nerve. Bulging, protruding, and herniated are all descriptions of the degree to which the "jelly" is either pushing on, or escaping through, the "donut."

These disk problems are very rarely the main reason for back pain (the most common cause is a muscle strain). Also, asymptomatic disk bulges and mild disk herniations are quite common, and are present in about a third of people between 20 and 40. The most common symptom resulting from a disk herniation is leg pain.

The nerves which innervate the hips and legs exit the lumbosacral spine between the vertebrae, and each nerve supplies strength and sensation to specific muscles and skin areas. Pressure on a nerve will result in pain, and possibly numbness and weakness, in its distribution. For example, L5-S1 herniation pushing on the left S1 nerve will cause pain in the left buttock and the back of the leg. The best way to confirm and evaluate such herniation is with an MRI study.

Buttock and leg pain arising from a disk herniation will commonly resolve with a combination of physical therapy and a home exercise/stretching program, activity modification, and antiinflammatory medications. If symptoms persist, treatment with a precise X-ray guided steroid injection, commonly referred to as a nerve block or epidural, is typically successful.

Surgery can be considered when a disk herniation is confirmed with an MRI, and the combination of the above treatments do not improve the pain to a comfortable level, or if numbness and/or weakness (which are signs of possible nerve damage) are present. Another reason to consider surgery is if symptoms are minimal at rest but are present with activities, and this results in significant limitations in life, such as inability to participate in sports.

The most common surgical treatment for a disk herniation is called Microdiscectomy. This minimally invasive surgery is typically performed with the help of a surgical microscope, and consists of removal of just the herniated disk material which is pressing on the nerve. The surgery takes about an hour and patients usually go home the same day. The success rate is typically very high; many patients feel a significant reduction in leg pain before they even leave the recovery room.

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