Lumbar Disc Herniation

Degenerative disc disease is a leading cause of chronic back pain as we age. It results from a complex interaction between spine structure, genetics, trauma and aging. Microtrauma accumulate over time and lead to mechanical damage to the discs, leading to the discs being unable to maintain their function of load distribution and shock absorption. 50-70% of individual risk of disc degeneration is attributed to genetics.

Intervertebral discs are pads of cartilage, filled with a fluffy cartilage center, that cushion the bones of each pair of vertebrae, provide shock absorption, and create space for the spinal nerves to exit the spine. With age and everyday wear and tear, the discs degenerate, flatten, and tear. Even a minor injury or strain causing the softer jelly like center to bulge or rupture into the spinal cord or the space where spinal nerves exit the spine.

Degenerative changes in the lumbar discs can have a major impact on other spinal structures and may affect their function and predispose them to injury. For example, loss of disc height changes load distribution in the spine and can cause arthritic changes in the vertebrae.

Symptoms of a herniated disc depend on the level of the spine where the herniation occurs. The pain of a herniated disc results from compression of the nerve or the spinal cord. Some people can have a herniated disc and no symptoms, while others will experience pain, weakness, and/or numbness.  Patients occasionally may have bowel or bladder issues.

When the herniated disc is in the lower back, the pain typically travels from the back along the affected nerve through the buttocks and down the leg. This is called radicular pain caused by a mechanical compression of the nerve.

Sciatica is a common type of radicular pain and often a symptom of a lumbar herniated disc. It causes deep and steady burning pain that worsens with sitting, driving and bending forward. Even the smallest of repetitive movements can create pressure on the cord or affected nerves and cause chronic pain. Pressure on the affected nerves causes the muscles to weaken and may cause a patient to stumble or impair walking and balance. It can also result in abnormal reflexes.

At your neurosurgical consultation, your Dallas Neurosurgical & Spine expert will take a thorough history, ask about your symptoms, the quality of the pain, the treatments that have been received, and how the pain affects your activities.  They conduct a physical examination including testing reflexes, muscle strength, and sensation. A neurological exam can help to identify the level of the herniation and it may be all that is necessary to diagnose a herniated disc. Imaging tests including x-rays, CT scans or MRIs will be ordered to identify other conditions that could cause or contribute to your pain, and to visualize the spinal cord and affected nerves.