According to the American Spinal Decompression Association, at some point in our lives, 80 percent of us will experience low back pain. While it is true that low back pain can be caused by a variety of issues, including muscle spasms, arthritis as well as back sprains and strains, a disc herniation, which is also referred to as lumbar disc disease, can also cause pain in the back.
Furthermore, when a lumbar disc is herniated, radiculopathy may result.
Radiculopathy (aka sciatica and sciatic neuritis) refers to a condition in which pain travels from the low back, down the buttocks and into the back of the leg. Although both legs can be affected, typically, sciatic neuritis only affects one leg at a time.
The Anatomy of the Lumbar Spine
Five moveable vertebrae make up the lumbar spine: These lumbar vertebrae are referred to as L1, L2, L3, L4 andL5, which sits directly above S1 (sacral vertebrae). The L5-S1 vertebral segment is frequently referred to as the lumbosacral joint.
The lumbar spine also consists of various muscles, ligaments and extremely sensitive nerves.
Each vertebra is composed of three functioning parts, the vertebral body, the vertebral neural arch and the bony processes.
Every Part Of The Vertebra Has Its Own Function:
- The vertebral body bears weight.
- The vertebral arch shields the neural elements (nerve roots and spinal cord) of the spine.
- The bony processes increase* the proficiency of muscle movements.
The Association Between the Vertebrae and Intervertebral Discs
The intervertebral discs connect the vertebrae to one another and serve as a cushion between each of the vertebral bodies. Whenever we run, jump or sit down, these discs are essentially the shock absorbers for our vertebrae.
Thus, reducing* the force that these actions place on the spinal column itself.
Intervertebral Discs: A Closer Look
Each intervertebral disc can be compared to a jelly donut: It has a soft center (nucleus pulposus) that is surrounded by strong fibrous tissues (ligaments). Besides surrounding the discs, these ligaments attach the vertebra to one another.
Degenerative Disc Disease (DDD)
As we age, our discs naturally begin to lose* water and height, which can affect the disc’s shape as well as its strength. This condition is referred to as Degenerative Disc Disease. In addition, DDD can be caused by an injury to the ligaments in the back.
As the disc degenerates, it is not uncommon for an individual to experience localized pain in the affected area.
A Disc Herniation, Explained
When a rupture of the nucleus pulposus occurs, the disc is considered herniated. Disc herniations occur most frequently at the L4-L5 and the L5-S1 segments. Every step we take puts the most pressure on the lumbar region of our spine.
Since the L4-L5 and L5-S1 are the last vertebral segments, they are more prone to sustaining a disc herniation. The constant force that is placed on them as well as their extensive range of motion makes them the most vulnerable vertebral segments in the spinal column.
Potential Changes at the L4-L5 Level That Can Lead to Pain
Degenerative changes and/or injuries to the L4-L5 vertebral segment can lead to pain in the low back and/or down the buttocks and the leg:
- Two joints that are referred to as the zygapophyseal joints or the facet joints connect to the L4 and the L5 vertebrae. If these joints degenerate or allow an abnormal amount of movement, pain is probable.
- If the L4 vertebra slips over the L5 vertebra, impingement of the nerve root will cause pain in the lower back and/or sciatica.
- There is a nerve that passes through the L4-L5 vertebral segment. This is the L4 nerve root. This nerve extends from inside the spinal canal to the back of each leg and then down. If any of the inflammatory proteins inside the intravertebral disc come into contact with the L4 nerve, or if something presses against this nerve root, the individual will experience sciatica.
- If the L4-L5 intervertebral disc degenerates or herniates, sciatica and/or low back pain is possible.
Potential Changes at the Lumbosacral Joint That Could Cause Pain
When considering the lumbosacral joint, this vertebral segment has numerous interconnected components that could lead to pain in the lower back and/or sciatica:
- Should the facet joints that connect the L5 and the S1 vertebrae to one another degenerate, or permit this segment of the spine to move in an abnormal fashion, pain is likely.
- If the intervertebral disc between L5 and S1 degenerates or its inner portion herniates, lower back pain and/or sciatica may result.
- Should the L5 vertebra slip forward over S1, the nerve root may be compressed; thus, leading to pain.
Recognizing the Symptoms of Lumbar Disc Disease
The symptoms an individual experience depends on where the herniated disc falls within the lumbar section of the spinal column as well as whether a nerve root is being impinged upon.
That said, common symptoms associated with lumbar disc disease include:
- Muscle spasms in the back.
- Continuous or sporadic pain in the back. This pain may worsen with movement, sneezing, coughing or standing for an extended period of time.
- Numbness in the foot and/or the leg.
- A decrease* in the reflexes at the ankle or knee.
- Weakened muscles in the legs.
- Variances in bowel and bladder function.
Since the symptoms associated with lumbar disc disease are similar to other medical problems or conditions, consulting a health care provider is essential.
Diagnosing a Herniated Disc
Individuals who suspect they have a herniated disc need to make an appointment with their physician. After performing a physical examination, if the physician believes that the individual may have a herniated disc, he or she will order diagnostic procedures.
Diagnostic procedures used to diagnose lumbar disc disease:
- Magnetic resonance imaging (MRI) – This procedure uses a computer, radio frequencies and large magnets to create detailed images of the spine.
- X-ray – Using electromagnetic energy beams, X-rays are capable of producing* images of organs, bones and internal tissues.
- Computed tomography scan (CT scan) – This imaging procedure combines X-rays with computer technology to create axial or horizontal imagery of the body. CT scans have the ability to show detailed images that include the muscles, bones, organs and fat. A CT scan is more detailed than an X-ray.
- Electromyography (EMG) – This test is used to measure the electrical activity or muscle response that occurs when the nerve is stimulated.
- Myelogram – This procedure involves dye being injected into the spinal canal. The dye makes the structure more visible on X-rays.
Treating Lumbar Disc Disease
The treatment an individual receives is determined by his or her physician.
Typically, the factors that are considered include:
- The type and extent of the condition.
- The age, medical history, and health of the individual receiving treatment.
- How well the individual can tolerate specific procedures, medications or therapies.
- The physician’s expectations concerning the advancement of the condition.
- The individual’s preference or opinion.
Initially, Most Physicians Use a Conservative Approach
Conservative therapy generally used to manage lumbar disc disease:
- Physical Therapy – May include therapeutic ultrasound, exercise programs, massage, cryotherapy or heat therapy.
- A back brace – To provide lumbosacral back support*.
- Weight control* – To reduce* the pressure placed on the lumbar spine.
- Discussing and demonstrating proper body mechanics – To decrease* the likelihood of causing additional damage to the disc and/or an increase* in the amount of pain an individual experiences.
- Medication – To reduce* muscle spasms and control* pain.
The majority of physicians do not recommend bed rest.
DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
If Conservative Treatments Fail
If the conservative treatments are not effective, the physician may recommend a microdiscectomy. A microdiscectomy is a minimally-invasive procedure in which the portion of the disc that is bulging out is carefully removed.
Once removed, the pressure that was being placed on the nerve root is relieved.
If an excessive amount of the jelly-like material inside the intravertebral disc is protruding from between the affected vertebrae, the entire disc may need to be removed and replaced. There are two options for disc replacement, a cadaver bone or an artificial disc that consists of a combination of medical-grade plastic and metal or solely of medical-grade metal.
When a cadaver bone is used to replace the disc, that particular area of the spine will eventually fuse together. Once fused, the individual’s range of motion in that area is limited.
Furthermore, for the sake of stability, it is not uncommon for surgeons to strategically place pins and rods consisting of medical-grade metal in the low back during surgery. These pins and rods remain in the back, indefinitely.
The patient will be given restrictions to follow. These restrictions are typically in place for several weeks following surgery: Adhering to these restrictions is essential as they are meant to prevent additional discs from herniating.
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