Johnston-Willis Hospital - January 14, 2020

The lower spinal column, also known as the lumbar region, consists of small, stacked bones called vertebrae that surround and protect the spinal cord and nerves. Low back pain is an ache or discomfort in the lumbar part of the spinal column and is very common. One of the most typical causes of lower back pain is a herniated disc, also known as a ruptured or slipped disc.

Over the course of a lifetime, almost 80% of Americans suffer from at least 1 episode of back pain. Every year, about 15%-20% of adults in the United States report back pain. Most pain gets better with time, but 5% to 10% of patients continue to have pain for longer than 3 months.

Causes of a herniated lumbar disc

A herniated disc occurs when the cushioning between the bones of the spine bulges out of place following normal, age-related changes, or injury. This causes a loss of water content, compresses the cushioning between the discs, and presses on the surrounding nerves. The result is pain, numbness, strange sensations, and/or weakness.

Risk factors

A risk factor is something that increases your chance of getting a certain disease or condition. A herniated lumbar disc is a normal part of aging for many adults. It is most common in men between 20 and 50 years of age. Other reasons that may result in a herniated lumbar disc include:

  1. Trauma to the back from falling, other types of accidents, or an awkward twisting of the back
  2. Lifestyle and Personal Health Factors
    • Obesity
    • Smoking
    • History of low back problems
    • Anxiety and depression
    • Inactivity
  3. Occupational Reasons
    • Heavy manual labor, such as a construction worker may experience
    • Heavy lifting that strains the back, such as firefighting
    • Exposure to vibrations, such as repeatedly using a jackhammer
    • A job that requires sitting or standing for long periods of time and forward bending, such as an airline attendant or office worker
  4. Health Conditions
    • Fractures in the back or other types of prior back injury
    • Tumors
    • Infections
    • Metabolic conditions, like diabetes

Symptoms

Symptoms of a herniated lumbar disc can range from mild to severe. Symptoms may include: 

  • Pain at the site of the herniated disc that may feel achy, throbbing, dull, or acute
  • Burning, tingling, or a shooting pain down the buttock or back of 1 leg, known as sciatica
  • Pain in 1 leg or buttock that may get worse with:
    • Sitting
    • Standing up
    • Coughing
    • Sneezing
    • Straining
  • Spasms in the muscles of the lower back
  • Muscle weakness or numbness in a leg or foot
  • Loss of reflex in the knee or ankle

More serious symptoms that require emergency care include:

  • Continuing weakness in a leg or foot
  • Numbness in groin or the buttocks
  • Difficulty walking, standing, or moving
  • Loss of bowel or bladder control (cauda equina syndrome)
  • Fever, unexplained weight loss, or other signs of illness

Diagnosing lumbar herniations

The symptoms of a lumbar disc herniation are similar to some other conditions. It is important to see your physician for a proper diagnosis. You will be asked about specific symptoms and your medical history before a physical examination is performed. Your doctor will focus attention on your back, hips, and legs. The physical exam also may include tests that measure strength, flexibility, reflexes, and sensory perception. Imaging tests may be used to evaluate the affected area, including:

  • X-rays
  • Myelogram—dye is injected into the spinal canal to make it more visible on an x-ray
  • Magnetic Resonance Imaging (MRI) Scan—uses a magnetic field and radio waves to create images of organs and surrounding tissue
  • Computed Tomography (CT) Scan—uses x-rays and computer imaging to create detailed images of bones, fat, organs, and muscle
  • Electromyography (EMG)—a nerve conduction study that measures the response of a muscle to electrical stimulation of a nerve

Treatment options

The goal of treatment is to reduce pain and lessen the risk of further injuring the spine. When possible, your doctor will use a non-surgical treatment option to help eliminate pain from the herniated disc. These options include 1 or more of the following:

Non-surgical Options

Activity

Bed rest is not generally recommended. It may be suggested for no more than 1 to 2 days for those with severe pain. Activity may be restricted for a period of time and then resumed as soon as possible. Recovery time may be shortened by staying active and exercising.

Medications

Medications used to treat lumbar herniations include:

  • Over-the-counter (OTC) or prescription pain relievers
  • Muscle relaxants to help control spasms
  • Corticosteroid injections in the back
  • Antidepressants or antiseizure medications for chronic pain

Physical Therapy

Physical therapy, such as:

  • Cold packs or heat therapy
  • Stretching and strengthening exercises
  • Massage
  • Ultrasound treatments or electrical stimulation
  • Posture education and appropriate lifting instructions
  • Use of a back support or neck brace

Alternative Therapies

While these therapies have not been proven by scientific studies to have an effect on lumbar herniations, some people may find some pain relief from:

  • Biofeedback
  • Acupuncture

If non-surgical treatments do not work and pain is worsening, it may be necessary to have minimally invasive surgery to correct the herniation. Surgical options include:

  1. Lumbar Microdiscectomy—uses 1 or more small incisions to remove the herniated part of the disc that is putting pressure on the spinal nerve
  2. Cervical Discectomy—the disc is either removed to relieve pressure or fused with bone in the empty space of the disc. Sometimes, the entire disc is replaced with an artificial disc made of metal and plastic.

Preventing lumbar disc hernias

To help reduce your chance of a lumbar disc herniation:

  • Use proper body movement when playing sports, exercising, or lifting heavy objects.
  • Be aware of your posture to reduce pressure on your spine.
  • Achieve or maintain a healthy weight.
  • Begin a safe exercise program with the advice of your doctor.
  • If possible, avoid sitting or standing in one position for long stretches of time.
  • Consider a change of job if your work requires a significant amount of heavy lifting or sitting.