What is Lumbar Disc Herniation?
The lower back is made up of five lumbar vertebrae, which are separated by lumbar discs that act as shock absorbers and keep the spine flexible and mobile. These intervertebral discs are made of an outer, tougher ring called the annulus fibrosus, and inner, softer, jelly-like material called the nucleus pulposus.
As the disc degenerates, the outer, tougher annulus weakens and allows the soft, inner nucleus to leak into the spinal canal. This is known as a disc herniation. This disc herniation, or disc bulge, can then put pressure on the nerve, causing sciatic symptoms including leg pain, numbness and weakness in the legs.
What are the symptoms of disc herniation?
Symptoms associated with herniated discs arise from the pressure or irritation caused by disc material on the nerve root specifically at the level where the herniation has taken place. The most common symptom of disc herniation is sharp leg pain, which increases with movement (Sciatica). Muscle weakness, loss of reflexes, and numbness or decreased sensation corresponding specifically to the compressed nerve root may also be present.
In rare but serious cases, the pressure on the nerve can be so severe that it can cause loss of ability to control the bladder and bowels. This condition is called “Cauda Equine Syndrome” and immediate medical intervention is indicated.
Diagnosis of Herniated Disc
A herniated disc diagnosis begins with a thorough history and physical examination that may include certain orthopedic tests such as “range of motion” and “straight leg raise” tests.
The physician may further evaluate the reflexes and test the strength of various foot muscles. Special spinal imaging may be ordered for further evaluation. Plain film X-rays can indicate level of degeneration in the spine, but only an MRI scan can determine the presence of a herniated disc.
Microdiscectomy is the most commonly performed surgery for herniated discs, and is recommended when conservative treatment such as rest, physical therapy, anti-inflammatory medication and epidural steroid injections are ineffective.
In this procedure, the disc bulge causing irritation and pressure to the nerve is surgically removed and the symptoms may improve instantaneously.
Potential Future Complications
The procedure may require an incision to be made in the wall of the disc to remove the herniation. This defect is typically not repaired at the end of the surgery due to the challenges of accessing the tissue needed to close the defect. The defect remains open in the disc and can act as a source of future complications.
Many surgeons now practice tissue preservation in their discectomy procedure by removing less of the disc material during surgery, with the intention of preserving the natural disc height. By preserving more of the disc, there will be less disruption to its structure, potentially decreasing the chance of disc collapse, which may result in improved long-term pain reduction. 17, 18, 19
In approximately 12-14.5% of patients, this defect can act as a channel where more disc material can spill or bulge out, causing future nerve irritation, resulting in a “re-herniation”. 15, 16
The Anchor System is a new option for patients undergoing herniated disc repair procedures, which enables the surgeons to perform the tissue sparing/disc preservation technique. Ask your surgeon if the Anchor System may be suitable for you.
Talking to your Doctor
The type of surgery can have a major impact on the treatment of herniated discs. Learning about the risks and benefits of the treatment can enable patients to make an informed decision about how they would like their care to proceed.
Questions you may want to ask your surgeon:
What are the risks or complications for a discectomy procedure?
Is there anything you can do to reduce the risk of disc reherniation?
What is currently done with the hole that is created in the disc?