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Anatomy of the discs

Your spine is made of 24 moveable bones called vertebrae. The lumbar (lower back) section of the spine bears most of the weight of the body. There are 5 lumbar vertebrae numbered L1 to L5. The vertebrae are separated by cushiony discs, which act as shock absorbers preventing the vertebrae from rubbing together. The outer ring of the disc is called the annulus. It has fibrous bands that attach between the bodies of each vertebra. Each disc has a gel-filled center called the nucleus. At each disc level, a pair of spinal nerves exit from the spinal cord and branch out to your body. Your spinal cord and the spinal nerves act as a "telephone," allowing messages, or impulses, to travel back and forth between your brain and body to relay sensation and control movement (see Anatomy of the Spine)

 

 

?What is a herniated lumbar disc

A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall (annulus). The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if low back and/or leg pain is going to resolve it will do so in about 6 weeks

 

 

Different terms may be used to describe a herniated disc. A bulging disc (protrusion) occurs when the disc annulus remains intact, but forms an outpouching that can press against the nerves. A true herniated disc (also called a ruptured or slipped disc) occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal

Most herniated discs occur in the lumbar spine, where spinal nerves exit between the lumbar vertebrae, and then join together again to form the sciatic nerve, which runs down your leg

 

lumbar disc 

 

?What are the symptoms

Symptoms of a herniated disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated lumbar disc, you may feel pain that radiates from your low back area, down one or both legs, and sometimes into your feet (called sciatica). You may feel a pain like an electric shock that is severe whether you stand, walk, or sit. Activity such as bending, lifting, twisting, and sitting may increase the pain. Lying flat on your back with knees bent may be the most comfortable because it relieves the downward pressure on the disc Sometimes the pain is accompanied by numbness and tingling in your leg or foot. You may experience cramping or muscle spasms in your back or leg

In addition to pain, you may have leg muscle weakness, or knee or ankle reflex loss. In severe cases, you may experience foot drop (your foot flops when you walk) or loss of bowel or bladder control. If you experience extreme leg weakness or difficulty controlling bladder or bowel function, you should seek medical help immediately

 

 

?Who is affected

Herniated discs are most common in people in their 30s and 40s, although middle aged and older people are slightly more at risk if they're involved in strenuous physical activity

Lumbar disc herniation is one of the most common causes of lower back pain associated with leg pain, and occurs 15 times more often than cervical (neck) disc herniation. Disc herniation occurs 8% of the time in the cervical (neck) region and only 1 to 2% of the time in the upper-to-mid-back (thoracic) region

 

?How is a diagnosis made

When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understand your symptoms, any prior injuries or conditions, and determine if any lifestyle habits are causing the pain. Next a physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness

Your doctor may order one or more of the following imaging studies: X-ray, MRI scan, myelogram, CT scan, or EMG. Based on the results, you may be referred to a neurologist, orthopedist, or neurosurgeon for treatment

 

 

?What treatments are available

Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, physical therapy, home exercises, hydrotherapy, epidural steroid injections (ESI), chiropractic manipulation, and pain management. With a team approach to treatment, 80% of people with back pain improve in about 6 weeks and return to normal activity. If you don’t respond to conservative treatment, your doctor may recommend surgery

 

?What is a lumbar disc

 

 

 

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