Herniated Lumbar Disk

Low Back Pain from a Bulging Disk

What is a herniated Lumbar disk?

The bony vertebrae are supported by cushions with a rubbery outer layer (annulus) filled with a jellylike center (nucleus).  This comprises your cervical disk.  Over time, as this tissue loses elasticity and due to repetitive stress, or if you have an injury to your neck, the inner nucleus can leak out of the annulus, putting pressure on the nerves.  This is often referred to as a herniated disk or a slipped disk.  

How does it occur?

This can occur due to an acute injury or wear and tear over time.  As you age, your disks tend to dry out and become less flexible.  This makes them more prone to herniation.  Sudden movement and straining while twisting, lifting, pulling or bending can cause a disk to herniate.  Genetics also play a role.

What are the symptoms?

If the herniated disk presses on a nerve root, you may feel numbness or tingling down your arm.  You may also experience weakness in that extremity.  If the herniated disk presses on your spinal cord, you may experience loss of balance and coordination.  Tingling shock-like feelings going down your legs.  Loss of strength and your legs may buckle or give out.

How is it diagnosed?

Diagnosis starts with a thorough history and physical exam.  You will be evaluated for range of motion, strength, and sensation in your neck and upper extremities.  An X-ray will be taken to evaluate bony structures and alignment of the vertebrae.  CT myelogram or MRI can give a greater detail image and provide 3D reconstruction of the bony and soft tissues.  An EMG or nerve conduction test can test the function of the nerves.

How is it treated?

Most herniated disks can be treated conservatively and may get better on their own with rest.  Tylenol with an NSAID (Advil/ibuprofen, Aleve/naproxen, or a prescription arthritis medication) are usually tried first to relieve pain and inflammation.  Physical therapy may be beneficial.  A stronger, short course of an oral steroid can be used to reduce inflammation in more severe cases.  Muscle relaxers can be prescribed to relieve painful muscle spasms.  Ice can be used for inflammation, and heat can be used for muscle spasms or soreness.

If these more conservative measures fail, the next step may be a steroid injection around the spine called an epidural block.  These can be given in a series of up to 3 injection over the course of several weeks.

 Rarely, in the most severe cases, or if symptoms do not get better in 4-6 weeks, surgery may be required.  A lumbar discectomy and fusion is a procedure where the herniated disk is removed and the vertebrae are fused together with hardware and bone graft.  In some cases, the lumbar disk can be replaced with an artificial disk.  

If you experience severe pain, weakness or numbness in your arms, loss of coordination or balance in your lower extremities, or a loss in bowel or bladder control, you may need surgery.,

What is the recovery time?

Conservative treatment of milder cases may take 6-8 weeks with medications and physical therapy.  

Epidural blocks may be given in a series of up to 3 injections, spaced out a few weeks apart and can give weeks to months of relief.

Surgery may be done as a same day surgery or with a 1 night stay in the hospital, with lighter duty for 4-6 weeks, and a full recovery in 2-3 months.  You may need to wear a back brace during the recovery process.

We are here to help. If you believe you are suffering from one of these conditions, we would love to deliver a diagnosis, get you treated and get you moving again.

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