What is lumbar herniated disc?

Many people with herniated discs have no symptoms. Pain happens when the bulging disc irritates the membrane on the outside of the spinal nerves. If the disc irritates or presses on the nerve roots in the spine, it can cause weakness or numbness in the area of the body where that nerve travels. If the herniated disc isn't pressing on a nerve, you may have an ache in your low back.

When the disc irritates or presses on a nerve in the lower back, symptoms may include:

• Pain that travels through the buttock and down a leg to the ankle or foot because of pressure on the sciatic nerve. There may also be low back pain.
• Tingling or numbness in one leg. It can start in the buttock or behind the knee and extend to the thigh, ankle, or foot.
• Pain in the front of the thigh.
• Severe deep muscle pain and muscle spasms.

Weakness in both legs and the loss of bladder or bowel control are symptoms of a specific and severe type of nerve root compression called cauda equina syndrome. This is a rare but serious problem. A person with these symptoms should see a doctor right away.

Usually symptoms from a herniated disc will get better on their own. So most people try nonsurgical treatment first. This includes taking over-the-counter pain medicines, using heat or ice, and doing suggested exercises. Some people take part in physical therapy or rehabilitation programs. If symptoms don't get better, surgery may be an option.

You can take steps to help prevent a herniated disc. Stay at a healthy body weight, get regular exercise, and use proper lifting techniques. Quitting smoking can also help, because smoking makes it harder for your spinal discs to absorb nutrients.

Medicine doesn't cure a herniated disc. But it may reduce inflammation and pain and allow you to start an exercise program to strengthen your stomach and back muscles. Medicines include:

• Pain relievers. These include acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen (such as Advil) and naproxen (such as Aleve).
• Muscle relaxants.
• Corticosteroids.
• Opioids.

Emergency surgery is done if a herniated disc causes cauda equina syndrome. Signs include:

• New loss of bowel or bladder control.
• New weakness in the legs (usually both legs).
• New numbness or tingling in the buttocks, genital area, or legs (usually both legs).

Surgery may be an option if:

• You have leg pain that hasn't improved with at least 6 weeks of nonsurgical treatment, you take strong pain medicine for your symptoms, and your symptoms are bad enough to interfere with normal activities and work.
• The nerve that the herniated disc is pressing on is causing weakness, loss of motion, or abnormal sensitivity in the area of the body that the nerve controls.
• Tests show that your herniated disc can be treated surgically.

Back surgery may relieve your pain faster than nonsurgical treatments. But over time, surgery and nonsurgical treatments work about the same to reduce pain and other symptoms. Some people need more disc surgery after their first surgery.

Many people are able to slowly get back to work and daily activities soon after surgery. In some cases, your doctor may recommend a rehabilitation program after surgery. It might include physical therapy and home exercises.

Disc surgery isn't thought to be an effective treatment for low back pain that is not caused by a herniated disc. Disc surgery is also not done if back pain is the only symptom that the herniated disc causes.

Surgery choices

There are different ways to remove disc material. They are:

• Open discectomy. This is done through a large cut, called an incision, in your back.
• Microdiscectomy. This is done through a smaller incision. It causes less damage to surrounding tissue.
• Minimally invasive procedures. These are done through one or more tiny incisions in your back. Your doctor can put special tools through the incisions, such as cutting or heating devices or lasers. These tools can cut or destroy part of the disc.

Studies haven't shown noticeable differences in how well each of these procedures works. So you and your doctor will think about several things in deciding which treatment may be right for you. These include your own body structure, your symptoms, which disc is herniated, what you prefer, and your doctor's expertise and experience.

In some cases, a small piece of bone from the affected vertebra may be removed. This small piece is called the lamina. It's the thin part of the vertebrae that forms a protective arch over the spinal cord. A procedure called a laminotomy removes some of the lamina. A laminectomy removes most of or all of the lamina. It also may remove thickened tissue that is narrowing the spinal canal. Either of these procedures may be done at the same time as a discectomy. Or they may be done separately.

You may not always be able to prevent a herniated disc from happening. But there may be some things that make it more likely to happen. Things that make it more likely you'll get a herniated disc are called risk factors.

Risk factors may include:

• Getting older.
• Having a history of back injury, previous herniated disc, or back surgery.
• Your job or other activities. These may include things like:
  • Lifting or pulling heavy objects.
  • Bending or twisting the back often.
• Your exercise habits, such as:
  • Not exercising regularly.
• Smoking. Nicotine and other toxins from smoking can keep your spinal discs from absorbing all the nutrients they need from the blood. This can make an injured disc more likely.
• Being overweight.

Some people use complementary medicine along with standard medical care to treat leg and back pain caused by a herniated disc. Some examples are acupuncture, manipulation of the spine, and massage. Talk to your doctor before using complementary medicine to treat a herniated disc.