Low Back Pain and Herniated Disc

Herniated disc is the most common reason of low back and leg pains. A disc refers to a cartilaginous tissue, which acts like a soft pad positioned in between the vertebrae. As this tissue lost its normal structure and function due to sprain, tears and ruptures occur. The ruptured part compresses the adjacent nerve that lies to the leg, and the symptoms develop. The most common symptoms of a herniated disc are blunt or sharp pain of the low back and legs, muscle spasm or cramp, and weakness and/or numbness of the legs. Sneezing, coughing or bending forward and twisting usually worsen the pain. Rarely, the control of defecation or urination is lost, and fecal and urinary incontinence occurs. In this case, a medical attention should be sought immediately.              

The sciatic pain (“the sciatica”) refers a pain that refers to the leg. The sciatica is usually a symptom of the herniated disc.  Sciatica is secondary to the compression of one or more than one nerve that forms the nerve with the same name and this condition is characterized with pain, burning, tingling and numbness that refer from the hip to the leg and sometimes to the foot. These symptoms and signs are generally unilateral (left or right).    

Risk factors of the herniated disc: Many factors increase the risk of herniated disc.

  • Life-style preferences such as smoking, lack of regular exercise, overweight, and malnutrition are main factors that contribute to the poor heal of the disc.
  • As the body ages, physiological biochemical changes lead to a gradual loss in the fluid content of the discs. Thus, the strength and the flexibility of the disc reduce. With aging, the discs may have a difficulty in absorbing the shocks arising out of our movements.
  • Poor posture habits, wrong exercises, and lifting heavy force the lumbar spine.

When these factors combine with the effects of daily tiredness, accidents, heavy lifting or bending; the possibility of herniated disc increases significantly. For instance, lifting an inappropriate object may rise the intradiscal pressure above 100 kg/cm2.

How is a Herniated Disc Diagnosed?

You should visit a doctor if you have severe low back and leg pains and numbness and strength loss in your legs. Your doctor will make a diagnosis by using the following methods: 

  • Physical examination and neurological examination
  • MRI (Magnetic Resonance Imaging), CT, if and when needed, and roentgnogram of the lumbar spine.
  • EMG (Electromyography)
Nonsurgical Treatment of Herniated Disc

Medical Treatment: You should definitely consult with your doctor before taking any of the medications.

Painkillers: A painkiller can be taken in order to relieve your pain. Mild-moderate pain can be treated through non-steroidal anti-inflammatory drugs (NSAIDs). These drugs reduce both pain and swelling in the tissue.    

Anti-inflammatory drugs: These drugs are used in order to reduce the swelling of the tissues damaged. 

Muscle relaxants: A muscle relaxant can be used in order to relieve your spasm.

Spinal Injection

Epidural steroid injection is an option, if the leg pain is very severe. Anti-inflammatory drugs are also injected nearby the affected nerves in the lumbar spine. You should consult with your doctor about this option, and be informed of the side effects before the treatment.      

Physiotherapy

Your doctor may recommend physiotherapy. Physiotherapy includes a combination of the treatments that help reducing the pain and increasing the flexibility. Hot and cold compressions, gentle massage, stretching and pelvic traction are some examples of the treatment; your physiotherapist will work with you in order to make the best treatment plan for your pain and other symptoms.  

Surgical Treatment of Herniated Disc

Herniated Disc is surgically managed in case of;

Pain that does not respond to medication treatment,

Very severe low back and/or leg pain,

Weakness in leg muscles, dropped foot,

In our day, the most successful treatment modality is microdiscectomy that is performed under microscope. The surgeon extracts a part of the bone covering the nerve, and exposes the herniated disc. This procedure is called laminotomy. Then, the nerve is decompressed by extracting a part of the disc between the vertebral bones and the herniated disc. The material extracted is always sent to a pathology laboratory.

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