Lumbar Disc Herniation – Causes, Diagnosis, Treatment

Lumbar disc herniation is a condition that results in lower back and leg pain. Some of the major symptoms of this condition include dull or sharp pain, sciatica, spasm in muscle, cramping, and leg weakness or loss of leg function. Most patients can experience increased pain during activities such as sneezing, coughing, or bending. In some rare cases, patients may even suffer from bowel or bladder control.

Sciatica is one of the most common symptoms associated with a lumbar herniated disc. This occurs when there is pressure on one or several nerves leading to pain, burning sensation, numbness or tingling in the back that extends from the buttock into the leg. In some cases, these sensations may even be felt in the foot. The condition usually affects one side of the body (right or left).

Risk Factors

A number of risk factors are associated with disc herniation. These include:

• Wrong lifestyle choices such as use of tobacco, lack of activity or regular exercise, and inadequate nutrition. These conditions contribute to poor disc health.
• With age, the body undergoes some natural biochemical changes leading to drying out of discs gradually. This may affect the overall strength of disc strength and resiliency.
• The natural process of ageing decreases the ability of intervertebral discs to absorb shock from body movements.
• Poor posture is another major risk factor of lumbar disc herniation. When combined with incorrect body mechanics. it stresses the lumbar spine and affects its normal ability to carry body weight.

Combining the above listed factors with regular affects from daily wear and tear, trauma, injury, incorrect lifting, or twisting, a disc may herniate leading to pain and discomfort. For instance, lifting something in an incorrect way may result in increased disc pressure (many hundred pounds per square inch)!

Causes

A herniation may develop all of a sudden or gradually over several weeks or months. There are four stages to a herniated disc. These include

Stage 1 - Disc Degeneration:

It is a result of chemical changes related to ageing. The process leads to weakening of discs sans a herniation.

Stage 2: Prolapse:

In this stage, the placement or form of the disc changes. This happens with slight spinal canal or nerve impingement. This stage is also referred to as a protruding disc or a bulging disc.

Stage 3: Extrusion:

In this stage, nucleus pulposus, the gel-like structure breaks through annulus fibrosis (tire-like wool). It does not move out of the disc.

Stage 4: Sequestered Disc / Sequestration:

In this stage, the nucleus pulposus breaks through the annulus fibrosus. Here, it may move outside the intervertebral disc.

Symptoms of Lumbar Disc Herniation

Some of the general symptoms of this condition include any one or a combination of the following listed below:

• Leg pain (sciatica) that may occur with or without lower back pain. Usually, the leg pain gets worse and more problematic than the lower back pain.
• Numbness, weakness and/or tingling in the leg
• Lower back pain
• Pain in the buttock
• Under rare cases, the patient may experience loss of bladder or bowel control. This is an indication of a serious medical condition referred to as 'cauda equina syndrome'.

Most patients can start feeling better (with pain subiding) within six weeks.

Treatment Options

A number of non-surgical treatments can help alleviate the pain. These are also very helpful in long term healing. Some of the most common nonsurgical treatments prescribed for herniated disc patients include:

• Physical therapy
• An epidural (cortisone) injection
• Osteopathic/chiropractic manipulation (manual manipulation)
• Oral steroids (e.g. prednisone or methyprednisolone)
• Heat and/or ice therapy
• Non-steroidal anti-inflammatory drugs (NSAIDs)

In the event pain, discomfort and other symptoms continue after six weeks, the doctor will suggest surgery after a detailed inspection. In case, the pain experienced is severe, the doctor may consider microdiscectomy surgery as an option.

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Compression Fractures – Understanding the Condition and Treatment Options

Compression fractures are a type of fracture in the spine. These are mainly caused by osteoporosis. Compression fractures may occur in vertebrae anywhere in the spine. However, the lower vertebrae of the thoracic spine (upper back) such as T10, T11, and T12 are more prone to the fracture. Upper lumbar segments (L1) may also experience compression fracture

Types of Compression Fracture

Wedge Fracture 

It usually occurs in the front portion of the vertebra collapsing the bone. The back portion of the same bone remains unchanged, causing the vertebra to take the shape of a 'wedge'. This kind of fracture is also termed as a mechanically stable fracture pattern. Wedge fracture is the most common type of compression fracture.

Crush Fracture 

The entire bone breaks instead of the front portion.

Burst Fracture 

The fracture results in height loss in front and back walls of the vertebral body. Burst fractures are unstable and result in neurologic compromise or progressive deformity.

Symptoms

• Acute back pain
• Chronic pain
• Height loss
• Deformity (thoracic kyphosis or dowager's hump)
• Crowding of internal organs
• Muscle loss
• Lack of activity leads to aerobic conditioning

A combination of the above symptoms of vertebral fractures may result in some significant changes in the self image of the patient which can adversely affect self-esteem. The patient also faces difficulty in concentrating and ability to carry on daily life activities. Since most of the damage is restricted to the front portion of the vertebral column, the fracture is stable and rarely result in spinal cord or nerve damage.

Treatment for Compression Fracture

Non Surgical Care

Compression fractures can be treated with non-surgical care. Patients are advised to rest and take medication to get relief from pain. Heat or ice packs can also help with pain relief and mobility.

Surgery

Surgery is recommended when the patient does not respond to medication and other non-surgical therapies. Vertebroplasty and Kyphoplasty are the two most common types of surgery for compression fractures.

Vertebroplasty 

It is minimally invasive treatment designed to decrease the intensity of pain or eliminate it completely. The surgery is performed to heal fractured vertebra and stabilize the bone. The surgeon injects low viscosity cement into the collapsed vertebral body under high pressure. This cement adds stability to the fracture and relieves back pain.

Kyphoplasty 

This is also a minimally invasive procedure that aims to decrease or heal the pain caused by a spinal fracture. The procedure also adds stability to the bone. It also restores some or all of the lost vertebral body height as a result of compression fracture.

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