By Don O. Stovall, Jr, MD

What is it?                           

Lumbar herniated disc (HNP) is a rupture or protrusion of the cushioning between the vertebral bones in the lower back.

The disc is the cushioning between the vertebral bones. It consists of an outer layer of rings of cartilage (annulus) and an inner layer of gel (nucleus). Healthy discs have a large content of water that   acts like a hydraulic cushion.

Causes                                

Herniated discs usually occur by an injury. The disc is usually weakened by wear and tear over time, making it susceptible to injury. The injury may be severe (fall or heavy lifting) or mild (cough or sneeze). In some cases, the patient cannot remember a specific event that caused the herniation.

Symptoms                         

*Back pain - the most common symptom. This may include back, buttock and/or groin pain.

*Leg pain - The disc usually ruptures to one side and pain runs down the leg. The affected leg may also feel numb, tingle or burn. Weakness can also occur, causing a limp.

*Severe symptoms include urinary retention (inability to empty the bladder) or foot drop (inability to raise the foot, causing it to drag)

Diagnostics                        

Tests your doctor may order to evaluate your herniated disc include:

History and physical examination

X-rays

MRI - to show which disc is herniated and which nerve is involved

Neurologic testing - EMG/nerve conduction studies to determine if there is any nerve damage and to rule out other conditions.

Treatment                           

Most herniated discs will heal over time. The treatment depends on the severity of the symptoms. Most symptoms will improve in 6-  8 weeks if the disc is healing.

*Medications - Anti-inflammatory medications

                           Pain medications

                           Muscle relaxers

                           Steroid pills - to reduce inflammation

*Spinal injections - Corticosteroid (cortisone) injections reduce inflammation within the spinal canal and provide an environment for the disc to heal. Up to three injections may be performed over a 6-8 week period of time.

*Surgery - Surgery is always a last resort. It is sometimes required   right away if severe symptoms occur, such as urinary retention or foot drop. It is also elected if at least 6-8 weeks of conservative treatment fails. Microdiscectomy is where the fragment of the ruptured disc is removed to allow the rest of the disc to heal and to remove pressure on the spinal nerves.