Treating a Lumbar Herniated Disc in Northern New Jersey
What Is a Lumbar Herniated Disc
The spine consists of 33 bones called vertebrae that form the spinal cord. The three sections of the spine are the cervical, thoracic, and lumbar regions. The lumbar area is the lower back. Between vertebrae are flat, round discs that provide shock absorption, support the upper body, and offer flexibility. As the name suggests, a lumbar herniated disc occurs in the lumbar region of the spine.
These discs have two parts — a soft inner nucleus (nucleus pulposus) and a durable outer ring called the annulus fibrosus. A herniated disc occurs when the shape of the annulus fibrosus is altered by a tear, leading to the nucleus pulposus bulging out of the annulus from between the vertebral bones, into the spinal cord and/or surrounding nerve roots. The herniated disc may also be called a ruptured disc. A bulging disc is similar but without any tear in the annulus.
Symptoms of a Lumbar Herniated DiscHerniated discs in the lower back protrude from the spine, pushing against nearby nerve roots. Additionally, inflammatory material from the punctured nucleus can irritate nerves, resulting in lower back pain, the primary symptom of a lumbar herniated disc. The pressure on the surrounding nerves causes pain that radiates down the associated extremities. Radiating pain is called radiculopathy. When the disc herniation occurs in the low back, pain and paresthesia radiate down the side and/or front of the leg or into the buttocks and may be the cause of sciatica. Other possible symptoms of a lumbar herniated disc include:
- Pain that worsens with coughing, sneezing, or straining
- Pain that exacerbates when sitting (increases pressure on the nerve)
- Dull or tingling sensation or weakness in the leg and or foot · Weakness or sensory differences at the lumbosacral nerve roots distribution
- Limited trunk flexion
- Radiculopathy down the leg, into a hip, or buttock
- Loss of bladder or bowel control
Risk Factors for Lumbar Herniated Disc
The main cause of a lumbar herniated disc is degeneration — the natural wear and tear of the spine that comes with age. Discs in children and young adults have a higher content of water, which helps support flexibility. With age, this water content decreases, and discs become more rigid. Simultaneously, discs get smaller, and the spaces between vertebrae get thinner. Given this degeneration, age is one of the most significant risk factors for herniated discs. Others include:
MVA or Sports Injury
Not all lumbar herniated discs stem from an underlying risk factor. Traumatic injuries, such as sports injury, fall, or motor vehicle accidents, can lead to herniated discs.
Sex and Age
Men ages 20 to 50 appear to be more likely to develop herniated discs than women or males outside this age range.
Being overweight or obese can put additional stress on lower back discs, potentially increasing the risk of herniation.
People who drive often may be more vulnerable to lumbar herniated discs. The combination of sitting for extended periods and the vibration from the engine can put pressure on the spine.
Some jobs require frequent, physically demanding tasks that tighten the spine, such as constant bending, lifting, or twisting. Adopting safe techniques for these motions can reduce the risk of a lumbar herniated disc.
Improper Lifting Practices
Individuals sometimes use their backs to pick up heavy objects instead of using their legs. This improper form increases the risk of herniating a lumbar disc. Twisting the body while lifting also can lead to this issue.
Some research suggests that smoking can increase the chances of experiencing disc degeneration. Findings indicate that nicotine can damage cells in the nucleus and annulus, affecting the functionality and health of discs. Smoking also can reduce oxygen to the disc, potentially accelerating degeneration.
As with many other health conditions, an inactive lifestyle can compound the risk of developing a herniated disc. Regular exercise can be beneficial in mitigating the likelihood of disc disorders, and physical therapists or pain management physicians may integrate it into a patient’s recovery.
Diagnosing a Herniated Disc in the Lower Back
Physicians may discuss symptoms with patients, ask about their medical histories, and conduct physical examinations. Two tests often used during the exam help confirm a herniated disc but are not 100% positive or negative. These tests include:
Straight Leg Raise Test
The straight leg raise (SLR) test can help diagnose a herniated disc but it needs to be confirmed with imaging. The patient lies on their back while the physician lifts the straightened leg, ensuring the knee remains straight. If the patient senses pain down the leg, they likely have a lumbar herniated disc.
A physician will perform a neurological examination to see if a patient with lumbar back pain has muscle weakness or numbness or myelopathy. The test involves:
- Monitoring the patient’s heels and toes when they walk to evaluate muscle strength and coordination, which is altered if the spinal cord is compressed by the herniated disc
- Testing the strength of the leg muscles and back.
- Administering a light touch on the leg and foot to see whether the patient has lost sensation.
- Testing ankle and reflexes (an absence of these reflexes may suggest a compressed nerve root in the spine)
If symptoms do not improve with conservative treatments, such as physical therapy, NSAIDs, epidural injections, or transforaminal injections, imaging may be needed to diagnose the structural cause of the symptoms of a herniated disc. The following are the primary imaging methods used in diagnosis:
MRI is one of the most effective techniques for diagnosing a suspected lumbar disc herniation. An MRI delivers clear images of soft tissues, including intervertebral discs and the spinal cord, making it ideal for detecting the possible causes of a herniated disc in the lower back. Most insurance plans require an x-ray to be ordered before ordering an MRI.
When necessary to use imaging to evaluate back pain, medical guidelines and insurance companies require an X-ray first. Standard x-ray images will include the following three views — AP (anterior-posterior), lateral, and oblique. These views assess the alignment of the spine and can reveal fractures, spondylolisthesis, and degenerative, spondylotic differences. If spondylolisthesis is potentially also a diagnosis, lateral flexion and extension x-ray views are necessary to evaluate spinal stability.
If X-rays detect narrow spaces between vertebrae, bone spurs, compensatory scoliosis, or a combination of the three, the patient likely has a lumbar herniated disc.
CT scans are a type of imaging technology utilized to view bones and organs. With a CT scan, physicians can identify bone pathology and calcified herniated discs. CT scans are an alternative for patients who cannot receive an MRI. However, since CT scans do not provide detailed images of soft tissue such as nerve roots, an MRI is preferred when diagnosing patients with symptoms of radiculopathy.
Treatment Options for a Herniated Lumbar Disc
Symptoms of a herniated lumbar disc tend to dissipate within a few weeks as the inflammation diminishes. Conservative treatments expedite the reduction of inflammation and would be recommended to prevent symptoms from persisting. Conservative, meaning non-surgical, treatments for a herniated disc in the lower back include:
Rest and Exercise
Immediately after an acute herniation, the most conservative treatment recommended is several days of rest to prevent further inflammation and relieve back and leg pain. CNSO physicians will provide patients with instructions on when and how to resume activity. Included will be home exercises that promote effective pain management.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective over-the-counter painkillers. They may alleviate, or at least reduce, the discomfort of a lumbar herniated disc. If patients do not respond well to NSAIDs, doctors may prescribe other non-opioid, including steroids, or opioid analgesics for only a short duration before advancing to pain management interventional treatment, such as epidural steroid injection or transforaminal injection.
Physical therapy is a hands-on, manual approach to alleviating pain through musculoskeletal massage, increasing the passive range of motion, and then strengthening the supporting muscles, all of which reduce the inflammation associated with back pathology.
Physical therapy provided by a CNSO doctor helps individuals with conditions like herniated lumbar discs regain their mobility, flexibility, and strength. In the case of a lumbar herniated disc, physical therapy will focus on the lower back and abdominal muscles. Techniques used by the certified physical therapists at Centers for Neurosurgery, Spine & Orthopedics include:
- Manual therapy
- Physical exercise
- Heat and cold therapy
- Ultrasound therapy
- Electrical stimulation
Since the symptoms of a herniated disc in the lower back often go away within a few weeks after physical therapy, most physicians will refer patients to a physical therapist at CNSO since they have significant experience in treating patients at all stages of recovery from a back injury.
Epidural Steroid Injection
Patients whose lumbar herniated discs coincide with radiculopathy and whose symptoms linger beyond four weeks may need epidural steroid injections. By placing steroids in the area of the herniated disc, interventional pain management physicians can eliminate the inflammation and pain caused by the herniated disc.
During the office-based or surgical center-based procedure, a doctor fellowship trained in pain management will use X-ray technology, called fluoroscopy, to visualize, in real-time, the exact location for injecting the needle.
Most patients will see an improvement in symptoms immediately after the procedure secondary to the local anesthetics injected. The injected steroids will take three to five days to become full effective. If the first injection series does not relieve symptoms, most physicians will not offer the procedure a second time. If the patient does experience relief from the epidural, if the symptoms return, a second can be offered. No more than 4 epidural injection should be done in one year. If the patient has their same pain return after the 3 injections, they should be evaluated for a surgical solution to the cause of the inflammation.
Spine and Back Surgery for Lumbar Herniated Disc
While conservative treatments help most patients overcome the symptoms of a herniated disc in the lower back, they cannot cure the cause of the inflammation. If the preceding solutions are not successful, a patient should be evaluated for a surgical solution. Symptoms that require back surgery when attributed to a spine structural abnormality include difficulty walking, muscle weakness, loss of function, loss of balance, and a loss of bowel and bladder control.
A discectomy involves removing a portion of the lumbar herniated disc to alleviate inflammation and pressure on the nerve root. A microdiscectomy is the removal of a portion of a disc, through a very small incision, using a microscope.
At Centers for Neurosurgery, Spine & Orthopedics, orthopedic spine surgeons or neurosurgeons can perform a microdiscectomy, or a minimally invasive discectomy, whichever would provide the patient with the best result and the quickest recovery time.
The entire procedure can be relatively quick, depending on how many discs require treatment. If a patient has only one herniated disc, it will only take one hour if performed by the CNSO surgeons. Once the surgery is complete, the patients can walk out of the surgical center or hospital.
Thereafter, patients can continue to walk on flat ground but should avoid more extreme motions, such as bending, lifting, or twisting, for at least two weeks. Patients will have follow-up appointments at one week, three months, and six months after the surgery, or any time if the patient were to have any concerns.
Vertebrae feature bony arches called laminae that create a roof-like structure over the spinal canal. Laminectomy is surgery that takes out a portion of laminae to allow nerve roots to move away from the spine. This back surgery can alleviate pressure from the spinal cord or nearby nerves, so it is sometimes called decompression surgery.
With CNSO surgeons, a laminectomy usually takes one hour unless the procedure required is a laminectomy and fusion surgery. If just a laminectomy, the patient will go home the same day.
Recovery time differs depending on the patient’s job, but most patients will need to limit bending, lifting, twisting, and similar activities for a short time. Post-surgical physical therapy can help build spinal strength and flexibility.
Find Comprehensive Care for Lumbar Herniated Discs in Northern NJ
Centers for Neurosurgery, Spine & Orthopedics takes a conservative approach to treat patients with disc disorders and other conditions affecting the brain, spine, and nerves. The comprehensive care team consists of board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists working together to create tailored treatment plans.
Whether patients need physical therapy, back surgery, or another pain management solution, they can find compassionate care at Centers for Neurosurgery, Spine & Orthopedics. Care is available at six locations throughout northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. Contact the team today to schedule an appointment.