Lumbar Disk Disease

About

What is lumbar disk disease?

Lumbar disk disease, or herniated disk, is one of the most common causes of lower back pain, as well as leg pain called sciatica. The spine includes 33 vertebrae (bones) that are separated by spongy or rubbery disks, about half an inch thick. These flexible disks act as shock absorbers for the spine when you walk or run. The vertebrae connect and create a protective canal around the spinal cord. The first seven cervical vertebrae are in the neck; the next 12 are in the chest area (thoracic); and the five lumbar vertebrae are in the lower back. There are five sacral vertebrae below the waist, and the final four vertebrae comprise the tailbone. Although a herniated disk can occur anywhere on the spine, it is in the lumbar area that most herniated disks occur. The neck area is also a common area for herniated disks. 

Running through the spinal cord are nerves that carry messages between your brain and muscles. Nerves branch out from the spinal cord through openings in the vertebrae. If a disk is injured or degenerates, it can bulge, slip, rupture or protrude into the spinal column through a tear in its tough outer layer (annulus). There’s not enough room in the spinal column for both the spinal nerve and a fragment of herniated disk. If the displacement presses on and irritates a spinal nerve it can cause pain or other symptoms. However, some people have no pain or other symptoms, and don’t know what caused their herniated disk. 

It is rare to need further treatment other than resting for a few days. About 90% of people who have a herniated disk get better in a few days to a few weeks. However, herniated disks usually mean they are in the early stages of degeneration and herniated disks can recur.

Causes

What causes lumbar disk disease?

Lumbar disk disease occurs when the normal structure of a disk is disrupted or changed. The most common cause is the gradual, wear-and-tear of aging. Disk material degenerates as one ages. The internal disk material can lose fluid, dry out and shrink, narrowing the spaces between the vertebrae. The ligaments that hold disks in place can weaken with age and lose their flexibility. This normal aging process makes the disks more prone to herniation. As disks become compressed, it often leads to a breakdown or a tear in the outer ring. The disk can bulge out or rupture into the spinal column. 

A severe injury or excessive strain can cause a normal disk to rupture or herniate. An injury can also cause a disk that’s already herniated to get worse and start causing pain or numbness. A disk already degenerated by age, but not causing symptoms, can also be ruptured by a minor strain or twisting movement.

Research has shown that herniated disks are sometimes common in several family members. This predisposition to disk problems increases the risk of ruptures at several places along the spine. 

Who’s at risk for lumbar disk disease?

Risk of a herniated disk is higher in people who are:

  • Older
  • Physically inactive with weak core muscles (abdominal muscles that support the back and keep the spine stabilized)
  • Physically inactive but occasionally participate in overly strenuous activities
  • Working in jobs that require heavy lifting and twisting of the spine
  • Overweight, which puts extra stress on the lumbar disks
  • Have a family history of herniated disks
  • Smoke tobacco, because it reduces oxygen to the disk and increases disk degeneration 
  • Male, between ages 20 to 50
  • Using their back muscles to lift heavy objects instead of their legs 
  • Driving for long periods of time – staying seated plus the engine vibration can put pressure on the spine and disks
  • Practice poor posture, which increases pressure on the spine and disks

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Symptoms

What are the symptoms of lumbar disk disease?

Symptoms can vary widely and depend on which disk is herniated, the position of the injured disk, size of the herniation, and which nerve is receiving the pressure. If the herniation is not putting pressure on a nerve, there may be no pain or symptoms, or only an ache in the lower back. Most painful herniated disks follow a long period of occasional or long-term low back pain.

The most common symptoms of lumbar disk problems include:

  • Back pain that is constant, or comes and goes; worse when you’re coughing, sneezing or standing for a long time
  • Muscle spasms in your back 
  • Sciatic pain, a sharp, shooting pain that starts near the back or buttocks, extending down the back of one leg into the foot; can be worse with standing, walking, or sitting
  • Weakness of leg or foot muscles
  • Numbness or a tingling sensation in a foot or leg
  • Poor reflexes in the knee or ankle
  • Changes in functioning of the bladder or bowel, or loss of control (incontinence); although rare it requires immediate medical attention

If the herniated disk is in the cervical spine, symptoms may include:

  • Neck pain that is dull or sharp, or pain between the shoulder blades
  • Pain that radiates down the arm to the hand or fingers
  • Numbness or tingling in the shoulder or arm that affects the ability to lift or hold items

Complications of a herniated disk can include severe back and leg pain, leg weakness or numbness, and loss of bowel or bladder control.

Diagnosis

How is lumbar disk disease diagnosed?

A physical exam plus one or more of the following tests may be used to diagnose lumbar disk disease. The American College of Radiology does not recommend an MRI until symptoms have been present for six weeks and are not improving.

The most commonly used diagnostic tests are:

  • Magnetic resonance imaging (MRI) is most commonly used, and can show the spinal cord, nerve roots, tumors, degeneration, and confirm the location of the herniated disk.
  • X-rays may be added to fully evaluate the vertebra, although X-rays cannot detect a herniated disk. 
  • Myelogram, an X-ray with contrast dye, can show pressure on the spinal cord or nerves caused by herniated disks, bone spurs or tumors. 
  • Computed tomography (CT) scan can evaluate the spine by using cross-sectional images of your spinal column and the structures around it.
  • Electromyogram, although rarely used, can measure the electrical impulse along nerve roots and in muscles. 
  • Straight leg raise is very accurate in diagnosing herniated disks in people younger than 35. Lying on your back, the doctor lifts the affected leg with your knee straight. Pain down the leg and below the knee often indicates a herniated disk.

A neurological exam can determine if you have muscle weakness or loss of sensation. You’ll be asked to walk on your heels and then toes to check muscle strength. Your reflexes and sense of touch will also be checked. Reflexes may be absent if you have a compressed nerve root in the spine.

Treatment

What are the treatment options for lumbar disk disease?

For the majority of people, symptoms and pain are relieved with rest and time. Your doctor may prescribe one or more of these therapies:

  • Modifying activities and movements that cause pain 
  • Bed rest for a day but no more than two days, although most spine specialists advise against staying in bed, preferring that you move around and walk if you can tolerate the discomfort 
  • Over-the-counter pain relievers
  • Physical therapy, including specific stretching exercises, gentle massage, pelvic traction, ice and heat therapy, ultrasound, and electrical muscle stimulation
  • Weight reduction
  • Lumbosacral back support
  • Medications to control pain and/or relax muscles
  • Learn correct body mechanics and posture to lessen the chances of causing more damage to the disk

The risks associated with non-surgical therapies include:

  • Enduring symptoms for a long time before you get relief
  • If you decide to have surgery after trying nonsurgical therapies for too long, surgery may provide less pain improvement 

There is convincing evidence that a steroid injection into the space around the nerve may provide short-term pain relief by reducing inflammation. This may be recommended if the above therapies have not helped after six weeks.

If pain or other symptoms continue, referral to a spine specialist or neurosurgeon is recommended. You may need to consider surgery to remove the protruding part of the disk. Rarely, the entire disk is removed, which usually requires the vertebrae to be fused with a bone graft. The process of bone fusion takes months, and metal hardware is placed in the spine to provide stability. Surgery does not guarantee pain relief, and is appropriate for only a small percentage of cases. 

Patients who are considered for surgery include those who:

  • Have pain that limits normal activity and affects quality of life
  • Leg or arm weakness and/or numbness is getting worse
  • Have significant problems with controlling their bowel or bladder
  • Have difficulty standing or walking
  • Have not been helped with medication and physical therapy

The risks of surgery can include:

  • Bleeding
  • Infection
  • Reaction to anesthesia
  • Nerve injury
  • Tear of the sac covering the nerves (dural tear)
  • Hematoma causing nerve compression
  • Greater relief of leg pain than back pain
  • Recurrent disk herniation and the need for further surgery

For a small percentage of cases, immediate medical attention and imaging is necessary if these symptoms are present:

  • Significant weakness in an arm or leg
  • Loss of feeling in the genital and rectal area
  • Loss of control of bladder or bowel
  • History of metastatic cancer
  • A recent infection or fever, especially an infected spinal nerve, accompanied by an injury that caused the pain
  • Weakness or numbness that is getting progressively worse

On average, there is a 5% to 10% chance that the disk will herniate again, regardless of the type of surgical or non-surgical treatment you have.

References

American Association of Neurological Surgeons. (N.d.). Herniated Disc. Retrieved 12-23-21, {https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc#:~:text=A%20herniated%20disc%20}
Mayo Clinic. (2019, Sept). Herniated Disk. Retrieved 12-23-21, {https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095}
Mayo Clinic. (2019, Sept). Herniated Disk Diagnosis and Treatment. Retrieved 12-23-21, {https://www.mayoclinic.org/diseases-conditions/herniated-disk/diagnosis-treatment/drc-20354101}
Park, D.K.,MD (2018, June). Herniated Disk in the Lower Back. American Academy of Orthopaedic Surgeons, OrthoInfo. Retrieved 12-23-21, {https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back/}
Johns Hopkins Medicine. (N.d.). Lumbar Disk Disease (Herniated Disk). Retrieved 12-23-21, {https://www.hopkinsmedicine.org/health/conditions-and-diseases/lumbar-disc-disease-herniated-disc}

Information

Medically reviewed by:

Dr. Desiree Levyim

Dr. Desiree Levyim is a board eligible neurologist in practice since 2020. She joins TeleMed2U in our mission to provide increased access to healthcare.

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Your copay
Depending on insurance

Without Insurance

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Initial Visit

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Follow Up