Lumbar disc herniation

This painful condition has many names: disc rupture, disc herniation, disc protrusion, or HNP (herniated nucleus pulposus). The intervertebral disc ages naturally due to dehydration. With progressive degeneration, fissures or cracks may develop, which in time can lead to a fragment of the disc separating when under pressure. This disc material may herniate (protrude) and cause nerve root compression. Disc herniations occur most commonly between the ages of 30-50 years.

The symptoms of a herniated disc are predominantly leg pain. Based on the specific nerve involved there will be associated numbness or weakness due to compression of that nerve. There is often minimal back pain.

The mainstay of treatment for lumber disc herniation is conservative (i.e. nonsurgical) treatment. This is because the majority of patient’s symptoms subside to a level allowing normal activities within 4-6 weeks. Our initial treatment often includes NSAIDS (non-steroidal anti-inflammatory drugs), as these reduce the inflammation that may be the causative factor in the nerve root pain. A progressive exercise program is designed and individualized by our physical therapists. Activities are modified but "bedrest" is avoided due to the deconditioning that results. Analgesics or muscle relaxants can help to relieve the acute pain in the beginning. Injections such as epidurals or selctive nerve root blocks can be helpful to control pain.

When non-operative treatment fails to relieve symptoms and return the patient to their normal activities, surgery may be considered. The type and timing of any operation depends on many factors such as: the type and location of the herniation, severity of the patients symptoms, degree of nerve root compression, and any previous spine surgeries.

NHNSI surgeons use the most advanced technology and the least invasive approach as is appropriate. A limited excision of a herniated disc for relief of a radiculopathy (leg pain) should provide relief in over 90% of properly selected patients. The relief of back pain as the predominate symptom is unpredictable, therefore is not typically an indication for this type of surgery.

As you read this information, keep in mind that all treatment and outcome results are specific to the individual. Only your physician can provide you with a detailed list of your specific indications, precautions, potential adverse events, and other important medical information.

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