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Lumbar Disc Herniation
Lumbar disc herniation is what occurs when there is a weakness in the outer part of the intervertebral disc, which allows inner material to herniates out and potentially press on the spinal nerve roots. This manifests with symptoms typically including pain, numbness, or weakness going down the legs in a particular distribution based on which nerve is compressed. The work up of this condition includes history, physical examination and advanced imaging studies. We then determine if there is a disc herniation, where it is, and the best course of action to follow.
First line of treatment
More than 75% of these cases can get better on their own and heal. The first line of treatment is typically oral medications such as anti-inflammatories, sometimes a short course of steroids in conjunction with physical therapy. Physical therapy aims to avoid compressing the disc any further while using several modalities for relief with local symptoms and also to help mobilize the nerves through what we call nerve glides as well as specific therapeutic exercises.
Second line of treatment
If physical therapy and other conservative means are not effective, we typically move to more invasive therapies such as spinal injections. The injection therapies provide a steroid, which is a very potent anti-inflammatory, to bathe the irritated nerve and provide direct anti-inflammatory effect. This can help the bothersome symptoms while the body heals the herniation.
Third line of treatment
When all other options have failed, that’s when surgery is indicated. The typical surgical approach is microdiscectomy. In this procedure a small window of bone and ligament are removed to safely allow identification of the herniated disc material. Only the herniated material is removed and the remainder of the disc bed is left intact. In doing so, we remove the pressure off the nerve root to allow for recovery and symptomatic relief.
With microdiscectomy surgery, typically the recovery is a course over three months. Work can be resumed as soon as a few days after surgery. Whenever we decompress a nerve that’s been agitated or has had pressure on it for a period of time, pain typically gets better the fastest, followed by any weakness, and finally by numbness. Unfortunately, numbness is the least predictable of all these things, and sometimes, depending on how much pressure or how long the pressure was applied, the numbness may stay. But thankfully, more often than not, the strength comes back and the pain goes away.
Be sure to watch this video for more information about lumbar disc herniation.