What is a lumbar herniated disc (LHD)?
A herniated (ruptured or “slipped”) disc results when a disc moves out of place or bulges and puts pressure on the adjacent nerves or nerve roots. This type of injury is relatively common. Repetitive movements, improper lifting, being overweight, and high-impact injury or simply the aging process can cause a disc to herniate. As we age, we become more susceptible to disc injuries over time. The discs start to degenerate: they dry out and can become cracked and torn. In addition, certain genetic factors can also predispose a person to disc degeneration and herniated disc.

Anatomy Involved: Intervertebral discs are the cushion-like pads that sit between the vertebrae of the spine; they act like shock absorbers and allow the spine to be flexible. A strong outer layer called the annulus fibrosus surrounds a soft center called the nucleus pulposus—much like a hard candy with a soft center. The spine is divided into regions. The vertebrae are numbered, and the discs are numbered by level. For example, the lumbar spine (lower back) vertebrae are labeled L1 to L5, and the discs are labeled L1-L2, all the way down to L5-S1 (where the spine joins the sacrum).

What are the symptoms of an LHD?
Several symptoms may suggest a LHD. Pain can range from a dull ache to a severe, sharp pain. Sciatica is a certain type of nerve pain that can be caused by a herniated lumbar disc compressing the sciatic nerve. You have 2 sciatic nerves, one on each side of the body. The sciatic nerve originates in the spine and extends down the leg. When a disc protrudes and presses on the sciatic nerve, pain extends from the buttock and thigh down into the leg and below the knee, sometimes even into the foot. You may have other symptoms, such as numbness of your leg or foot, tingling or burning sensations (paresthesias), muscle spasms and/or weakness, abnormal reflexes, and, in severe cases, loss of bladder or bowel control (which constitutes a medical emergency and needs immediate attention).

How is a lumbar herniated disc diagnosed?
Diagnosis begins with a history and physical examination. Your doctor asks about your symptoms and will assess certain body movements. If straight leg raising (lifting up the leg while lying down) produces pain that radiates down your leg, a diagnosis of LHD is likely, especially if you have other symptoms, such as numbness or paresthesias.

Although X-rays may help rule out other conditions—a fracture, for example—other imaging studies, such as magnetic resonance imaging (MRI), are needed for a diagnosis of lumbar herniated disc. X-rays do not show soft tissues such as discs and nerves. Further tests, such as nerve conduction studies and an electromyogram (EMG) are needed to confirm that a herniated disc is the culprit.

What’s the lowdown on low back pain and sciatica?
While low back pain is a common ailment, sciatica occurs less frequently. Approximately 80% of the general population experiences low back pain at some point, but only 2-3% of people with low back pain actually have sciatica.

• Most cases of LHD occur in people aged 30 to 50 years.
• The most common level of herniation is L4-L5, followed by L5-S1.

Will I need surgery?
Herniated discs and sciatica often heal on their own with appropriate care, such as medications for pain and spasm, injections, and physical therapy. If the symptoms progress and if neurologic problems (such as shooting pain or numbness in the leg) become more severe, or if weakness in the leg or foot gets worse, surgery may be indicated.

Several types of spine surgery are available. The type you may require depends on your particular condition and circumstances.

Next, let’s discuss finding an appropriate spine surgeon who will draw up the best treatment plan for you—whether or not you actually need surgery.

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