Disk Herniation

What is a lumbar disk?

A lumbar disk, or intervertebral disk, is a sac filled with a gel-like material found between your vertebrae. Your vertebrae are the bones in your back that are linked together to form your spine. Your lumbar disks and vertebrae are located in your lower back. Your vertebrae and disks help your spine and body support your weight. Your spine surrounds your spinal cord that contains your nerves. Your disks allow your body to make certain movements such as bending and twisting. Your disks also help protect your spine from being damaged by your strong back muscles.

What is a lumbar disk herniation?

Lumbar disk herniation occurs when the gel-like material bulges or leaks out from your vertebrae. The herniated disk may press on your nerves or spinal cord. A herniated lumbar disk may be painful and decrease your movement. Having your lumbar disk herniation treated may decrease your pain. Treatment may also prevent your nerves or spinal cord from being permanently damaged.

What causes lumbar disk herniation?

• Cracked vertebrae: Cracks or changes in the shape of your vertebrae may increase your risk for disk herniation. The gel-like material inside your disk may leak out of the cracks. The whole disk may also begin to bulge out of the cracks in your vertebrae.
  
  
• Disk weakening: Disk weakening occurs if the gel-like material inside decreases. The disk loses its cushion and may bulge out from between your vertebrae. Your disks often begin to weaken as you age. You may also have disk weakening if you often drive long distances, or sit most of the time.
  
  
• Injury: Your disks cushion the forces that occur when you fall, twist, or strain your back. A disk may herniate if these forces are very strong, or if your disks are weakened. Straining your back may occur with heavy lifting or during heavy physical activity.

What are the signs and symptoms of lumbar disk herniation?

Mild lumbar disk herniation may not cause any signs and symptoms. You may have signs and symptoms if your herniated disk presses against your nerves or spinal cord. Lumbar disk herniation may cause a condition called sciatica. Your sciatic nerve starts in your lower back and moves down past your buttock into your leg. With sciatica, you may feel burning, stabbing, or tingling pain that shoots down one or both your legs. Ask your caregiver for more information about sciatica. You may also have the following signs and symptoms:

• Pain in your lower back, buttocks, groin, or legs. Your groin is the area between your upper thighs and hips. You may have sudden pain after bending, stretching, or twisting your back. The pain may decrease with rest and worsen when walking, standing, or sitting for a long time.
  
  
• Numbness (less feeling) or weakness in one leg.
  
  
• Trouble walking or moving your feet or toes.
  
  
• Changes in how you sit and stand. You may hold your back straighter or lean or twist to one side.

How is lumbar disk herniation diagnosed?

Your caregiver will ask you about your symptoms and any health problems you may have. He will do a physical exam and check your movement. Your caregiver may look at your spine and feel for any abnormal areas along your spine. Tell your caregiver if there are areas on your spine that are painful when touched. Your caregiver may check the strength of your legs. He may check your reflexes in your ankles and knees. He may also check the feeling in your feet. You may also have any of the following tests:

• Straight leg raise test: This test is also called the SLR or Lasegue test. It checks if your disk is pressing against your nerves or spinal cord. Your caregiver will ask you to lie flat on your back, with your legs straight. He will then raise one of your legs as far as he is able. Tell your caregiver to stop if the test causes you pain. Your caregiver will then do the SLR test with your other leg.
  
  
• Slump test: This test also checks if your disk is pressing against your nerves or spinal cord. Your caregiver will ask you to sit down on an exam table, with your legs dangling and your back straight. He will then ask you to slump over while looking straight ahead. Your caregiver will then have you look down, stretch out one leg, then point your toes up toward the ceiling. Tell your caregiver what you feel every time you are asked to make a new movement. You will be asked to repeat this test using your other leg.
  
  
• Imaging tests: These tests may use a dye to help your caregiver see the pictures better. People who are allergic to iodine or shellfish (crab, lobster, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish or have other allergies.
  
  
  • Magnetic resonance imaging: During magnetic resonance imaging (MRI), pictures are taken of your lower back. An MRI may show a bulging disk, and if it is pressing on your nerves and spinal cord. Never enter the MRI room with any metal objects. This can cause serious injury.
    
    
  • Computed tomography scan: A computed tomography (CT) scan uses a special machine to take pictures of your lower back.
    
    
  • Myelography: A myelography is an x-ray picture of your spinal cord. Dye will be given as a shot into the area around your spinal cord before the pictures are taken.
    
    
  • X-ray: An x-ray picture may be taken to check for abnormal areas in your lower back.
    
    
  • Discography: Discography is done to learn if your bulging disk is what is causing your pain. During this test, your caregiver injects dye into the disk he believes is herniated. When the injection is done, you may feel pain. After the injection, you may have a CT scan done to look at your disk. Ask your caregiver for more information about discography.

How is lumbar disk herniation treated?

Your caregiver may have you rest in bed for a few days. It is best to rest on your side with your knees bent. Putting a cushion between your knees may help decrease the pressure on your spine and nerves. You may be treated with any of following:

• Medicines:
  
  
  • Pain medicine: You may need medicine to take away or decrease pain.
    
    
    • Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.
      
      
    • Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.
    
    
  • Muscle relaxers: This medicine helps relax your muscles. It is also given to decrease pain and muscle spasms.
    
    
  • Nonsteroidal anti-inflammatory medicine: This type of medicine is also called NSAIDs. NSAIDs may decrease pain and inflammation (swelling). This medicine can be bought with or without a doctor’s order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine. Ask your caregiver if you have any questions about NSAIDs.
    
    
  • Steroids: Steroid medicine may be given to decrease inflammation, which is pain and swelling.
  
  
• Injection therapy:
  
  
  • Chemonucleolysis: During chemonucleolysis, your caregiver will give you a shot of medicine into your herniated disk. The medicine used for this treatment works by shrinking your bulging disk.
    
    
  • Epidural injections: An epidural injection is medicine given as a shot into the area of your disk herniation. The injection may numb the area and decrease your pain.

• Physical therapy: During physical therapy, you will work with a special caregiver on exercises to make your back stronger. These exercises may also help to decrease your pain. You will need to start slowly and increase your activity as you get stronger. Physical therapy may help you return to your usual activities faster. You may also learn better ways to bend, lift, sit and stand to decrease your risk for low back pain. During physical therapy, you may also have the following:
  
  
  • Deep heat ultrasound: During deep heat ultrasound, a small plastic or metal device will be moved around your lower back. The device uses heat to reach your deep tissues and decrease your pain. The heat may also decrease any swelling and help heal your tissues.
    
    
  • Traction: During traction, a special device is used to stretch your spine. Stretching your vertebrae may decrease the pressure on your nerves and lessen your pain. Ask your caregiver for more information about traction.
  
  
• Surgery: You may need surgery to fix your herniated disk if other treatments have failed. Surgery may be done to remove your herniated disk and make your spine stronger. Surgery may also be done to decrease pressure on your nerves and spinal cord. Ask your caregiver for more information about the different surgeries for herniated disks.

What can I do to help decrease the pain from a lumbar disk herniation?

• Ice and heat: Putting ice or heat on your lower back may help decrease your pain. Ask your caregiver for more information about how often to apply ice or heat.
  
  
• Acupuncture: Acupuncture may help decrease your pain and swelling. Talk to your caregiver for more information about acupuncture.
  
  
• Exercise and activity: Try not to sit for long periods of time. Avoid heavy lifting while your back is healing. Exercises that do not stress your back muscles may help decrease your pain. Examples of low stress exercises are walking, swimming, and biking. Talk to your caregiver before starting any new exercise program.

Where can I find support and more information?

The pain from a disk herniation may cause you to feel stressed and sad. The pain that you feel may make it hard for you to do your usual activities. Your caregiver may work with you to learn ways to cope with your feelings. Your caregiver may also help you find ways to stay relaxed and calm. Learning to cope with your pain may help you stay focused on your healing. Talk to your caregiver, family, and friends about your feelings. Contact the following for support and more information:

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont , IL 60018-4262
  Phone: 1- 847 - 823-7186
  Web Address: http://www.aaos.org/
  

• American Chronic Pain Association
  PO Box 850
  Rocklin , CA 95677
  Phone: 1- 800 - 533-3231
  Web Address: http://www.theacpa.org
  

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You have decreased feeling and numbness in one or both of your legs.
  
  
• You have pain when resting.
  
  
• You have trouble moving one or both of your legs.
  
  
• You have worsening pain at night.
  
  
• Your pain worsens even after taking your medicines.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care or call 911 if:

• You begin leaking urine or stool, and it is not normal for you.
  
  
• You do not feel anything when you urinate or have a bowel movement.
  
  
• You are unable to move one or both of your legs.
  
  
• You lose feeling in your groin or buttocks.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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