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Lumbar Disc Herniation

WHAT YOU NEED TO KNOW:

What is lumbar disc herniation?

Lumbar disc herniation occurs when a lumbar disc bulges out. Lumbar discs are spongy cushions between the vertebrae (bones) in your lower back. The herniated disc may press on your nerves or spinal cord.

What causes lumbar disc herniation?

  • Cracks or changes in the shape of your vertebrae may increase your risk for disc herniation. The gel-like material inside your disc may leak out of the cracks. The whole disc may also begin to bulge out.
  • Weak discs may develop if the amount of gel-like material inside the disc decreases. This causes the disc to lose its cushion and bulge out from between your vertebrae. Discs can weaken with age. Your discs may also weaken if you often drive long distances, or sit most of the time.
  • A back injury may weaken a disc or cause it to bulge. A back injury may occur if you strain your back during heavy lifting or heavy physical activity.

What are the signs and symptoms of lumbar disc herniation?

Mild lumbar disc herniation may not cause any signs or symptoms. You may have any of the following if the herniated disc presses against your nerves or spinal cord:

  • Burning, stabbing, or tingling pain that shoots down one or both of your legs
  • Pain in your lower back, buttocks, groin, or legs
  • Numbness or weakness in one leg
  • Trouble walking or moving your feet or toes

How is lumbar disc herniation diagnosed?

Your caregiver will ask you about your symptoms and any health problems you may have. He may examine your spine for any abnormal areas. Tell him if any area on your spine is painful when touched. He may also check the reflexes in your ankles and knees. You may also need any of the following tests:

  • A straight leg raise test is done to check if your disc 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 each leg one at a time as far as he is able. Tell him to stop if the test causes you pain.
  • A slump test is done to check if your disc is pressing against your nerves or spinal cord. You will sit with your legs dangling and your back straight. Your caregiver will ask you to slump over while you look straight ahead. He will then have you look down, stretch out one leg, and point your toes toward the ceiling. Tell him what you feel every time you are asked to make a new movement. You will be asked to repeat this test with your other leg.
  • An MRI or a CT scan may be used to take pictures of your lower back. The pictures can show a bulging disc or if the disc is pressing on your nerves and spinal cord. You may be given contrast dye to help the pictures show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body.
  • A myelography is an x-ray of your spinal cord. Dye will be given as an injection into the area around your spinal cord before the pictures are taken.
  • An x-ray of your lower back may be taken to check for abnormal areas.
  • Discography is done to learn if a bulging disc is causing your pain. During this test, your caregiver injects dye into the disc he believes is herniated. After the injection, your caregiver may use a CT scan to look at your disc.

How is lumbar disc 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. Put a cushion between your knees to help decrease the pressure on your spine and nerves. You may also need any of following:

  • Medicines:
    • NSAIDs decrease swelling and pain. This medicine is available without a doctor's order. Ask your caregiver which medicine is right for you, and how much to take. Follow directions. NSAIDs can cause stomach bleeding or kidney problems if not taken correctly. If you take blood thinner medicine, always ask your caregiver if NSAIDs are safe for you.
    • Prescription pain medicine may be given . Do not wait until the pain is severe before you take this medicine.
    • Muscle relaxers and steroids may also be given. Muscle relaxers decrease pain and muscle spasms. Steroids decrease inflammation.
    • Injections of medicine may also be given. Chemonucleolysis helps shrink your bulging disc. An epidural numbs the area near the bulging disc and decreases pain.
  • Physical therapy may be recommended by your caregiver. A physical therapist teaches you exercises to make your back muscles stronger and decrease your pain. A physical therapist can teach you safe ways to bend, lift, sit, and stand to decrease your risk for low back pain.
  • Surgery may be needed to fix your herniated disc if other treatments have failed. Surgery may be done to remove your herniated disc and make your spine stronger. Surgery may also be done to decrease pressure on your nerves and spinal cord.

How can I manage pain from a lumbar disc herniation?

  • Apply heat. Heat helps decrease pain and muscle spasms. Apply heat on the area for 20 to 30 minutes every 2 hours for as many days as directed.
  • Do low-stress exercise and activity. Exercises that do not stress your back muscles may help decrease your pain. Examples of low-stress exercises are walking, swimming, and biking. Avoid heavy lifting while your back is healing. Try not to sit for long periods of time. Talk to your caregiver before you start any new exercise program.

When should I contact my caregiver?

  • You have numbness in one or both of your legs.
  • You have low back pain while resting.
  • You have trouble moving one or both of your legs.
  • You begin leaking urine or bowel movement, and it is not normal for you.
  • Your pain gets worse, even after you take medicine.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You cannot control 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. 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.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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