Lumbar Disc Herniation

Most herniated disks occur in the lower back. Symptoms depend on where the disc is situated and whether the disc is pressing on a nerve. Common symptoms include:

• Arm, back, or leg pain, often described as sharp or burning.
• Numbness or tingling
• Muscle weakness

Discs are thick cushions made of cartilage that sit between each vertebra of the spinal column. Discs play a vital role in absorbing the forces placed on the spine during movement.

Discs can become weak and damaged through age or trauma caused by excessive pressure, such as heavy lifting. This damage is called “herniation”, an abnormal protrusion of the soft gel-like core (nucleus) of the disc into or through the strong outer wall of fibres (annulus).

Disc herniation can occur in four ways:

1. Degeneration, where the disc becomes weak and thinner and may shrink with age.
2. Disc prolapse, where the disc has a pronounced bulge that puts pressure on the spinal canal or a nerve.
3. Extrusion, where the nucleus ruptures through the annulus but remains in one piece.
4. Sequestration, where the nucleus ruptures through the annulus but is separate from the main portion of the disc.

In most cases of a herniated disc, a physical exam and a medical history is all that is required for a diagnosis. If Dr Shiva suspects another condition or needs to see which nerves are affected, they may order one or more of the following tests.

• An X-ray cannot show if you have a herniated disc. It can, however, show Dr Shiva the outline of your spine and rule out whether your pain is caused by something else, such as a fracture or tumour.
• A myelogram uses dye injected into your spinal fluid and an X-ray to locate the pressure on the spinal cord.
• A CT scan takes several X-rays from different angles. It combines them to create images of your spinal cord and the structures surrounding it.
• MRI images can locate the position of the herniated disk, look inside it, and determine which nerves are affected.

Few people with herniated disks require surgery. If nonsurgical treatments such as medication and rest fail to improve your symptoms, Dr Shiva may suggest surgery.

Surgery is considered when patients experience:

• severe or persistent back or leg pain
• weakness or numbness of the legs or feet
• difficulty walking and standing
• bladder and bowel symptoms

In nearly all cases, surgeons can remove the protruding portion of the disk. A surgeon will rarely need to remove the entire disc. The vertebrae might need to be fused with a bone graft in these cases.

Surgery generally takes 1-2 hours, and most patients can be discharged after 1-2 days. Most patients can return to their normal activities after lumbar disc surgery.

Postoperative care

• No lifting more than 5kg, no bending or twisting for six weeks
• No driving for two weeks
• Keep the wound dry for five days. You can get wet in the shower, but pat the area dry rather than rub.
• GP review postoperatively for wound review on day seven
• Monitor for any wound redness, discharge or fevers
• Monitor for new symptoms, including worsening back or neck pain, arm or leg pain, pins and needles or numbness
• Six-week review with Dr Shiva