Low Back Pain and Herniated Disc

Low Back Pain and Herniated Disc

The most common cause of back and leg pain is a herniated disc. The disc is a cartilaginous tissue that acts as a cushion between the vertebrae. With strain, this tissue loses its normal structure; tears and ruptures occur. The bulging portion immediately puts pressure on the nerve that goes to the leg in its vicinity, causing symptoms. Symptoms of a herniated disc include dull or sharp pain in the lower back and leg, muscle spasms or cramps, weakness in the legs, and/or numbness. Sneezing, coughing, bending forward at the waist, or twisting usually increases the pain. Rarely, fecal or urinary incontinence may occur, resulting in the loss of control over bowel movements or urination. In this case, immediate emergency medical help should be sought. Pain radiating to the leg is known as "sciatica". Sciatica is generally a symptom of a herniated disc in the lumbar region. Sciatica, caused by pressure on one or more nerves forming the sciatic nerve, can result in pain, burning, tingling, and numbness that radiates from the hip down the leg and sometimes to the foot. These symptoms and findings are typically unilateral (left or right).

Anatomy: Between the five lumbar vertebrae, there is a structure called a disc, consisting of hard outer tissue and relatively soft inner tissue. The function of the discs is to provide flexibility to the lower back and absorb shock impacts. Each disc has a gel-like inner substance (nucleus) and a rubber-like outer ring. Disc herniation occurs when the outer ring weakens or tears, causing the nucleus to escape outside the ring (thick arrow). The herniated portion puts pressure on the nerve that goes to the leg in its immediate vicinity (small arrow), causing pain; In more advanced cases, it prevents the nerve from conducting impulses, and weakness and numbness in the affected leg occur.

Risk factors for herniated disc: Several factors increase the risk of disc herniation

Lifestyle choices such as smoking, lack of regular exercise, excess weight, and improper nutrition greatly contribute to poor disc health.

As the body ages, natural biochemical changes lead to a gradual decrease in the water content of the discs, which affects their strength and flexibility. With aging, the discs may become less able to absorb the shocks from our movements.

Incorrect body posture habits, improper exercise, and heavy lifting strain the lumbar spine. When these factors combine with daily wear and tear, accidents, or improper lifting or bending, the likelihood of developing a herniated disc significantly increases. For example, removing something incorrectly may cause the internal disk pressure to rise above 100 kg/cm².

How Is a Herniated Disc Diagnosed?

If you experience severe back and leg pain, numbness in the leg, or loss of strength, you should see a doctor.

• Physical examination and neurological examination
• MRI, sometimes spinal CT, and plain spinal X-ray
• EMG

Your doctor will diagnose you using these methods.

Non-Surgical Treatment of Herniated Disc

Self-administrable practices:

Resting on a medium-firm mattress for 3-5 days Cold Therapy:

During the first 24-48 hours, cold therapy helps reduce swelling, muscle spasm, and pain by decreasing blood flow. Never apply cold or ice directly to your skin; instead, wrap the ice pack or cold pack in a towel and apply it to your lower back for no more than 15 minutes.

Heat therapy: Generally, heat therapy can be applied after the first 48 hours. Heating the soft tissues and providing relaxation increases blood flow. Increased blood flow helps clear irritating toxins that may accumulate in the tissues as a result of muscle spasm and disc injury. Do not apply heat directly to your skin (just as you would with cold); instead, wrap the heat source in a thick towel and limit the application to no more than 20 minutes.

Medication Treatment: Before taking any of these medications, be sure to consult your doctor.

Painkillers: May contain painkillers to relieve pain. Mild to moderate pain can be treated with non-steroidal anti-inflammatory drugs (NSAIDs). These reduce both tissue swelling and pain.

Anti-inflammatories: These medications are used to reduce swelling in damaged tissues.

Muscle relaxants: Muscle relaxants are taken to relieve spasms.

Spinal injection

If leg pain is severe, an epidural steroid injection may be administered. Additionally, it delivers anti-inflammatory medications near the affected nerves in the lumbar spine. Discuss this option with your doctor and inquire about potential side effects before starting this treatment.

Physical Therapy

Your doctor may recommend physical therapy. Physical therapy involves a combination of treatments to reduce pain and increase flexibility. Ice and heat therapy, gentle massage, stretching, and pelvic traction are a few examples, but your physiotherapist will work with you to develop the best treatment plan for your pain and other symptoms.

Some herniated discs rarely cause bowel/bladder control problems. In this case, emergency medical surgery must be performed. If surgery is recommended, ask about the purpose of the surgery and its possible outcomes. You must understand all the details of what is being proposed and should not hesitate to seek a second opinion from another spine surgeon. Spine surgery is a major decision, so do not make it hastily. Surgery is performed to relieve nerve compression and leg pain. During the surgery, all or part of the disc pressing on the nerve is removed. This procedure is performed under a microscope.

Today, the most successful treatment method is the "microdiscectomy" surgery performed under microscope. The surgeon accesses the herniated disc by removing a portion of the bone covering the nerve. This procedure is called laminotomy. Later, along with the herniated disc, a portion of the disc between the vertebrae is also removed to relieve pressure on the nerve. The removed material is always sent to pathology. The surgery can be performed using minimally invasive techniques.

Minimally invasive spine surgery does not require large skin incisions; instead, it uses small incisions and specialized tiny instruments and devices such as microscopes during the operation. Since 2016, in our hospital, Op. Dr. Cevdet Gökçek has performed nearly 50 microdiscectomy surgeries under microscope and achieved successful results in all patients. No patient experienced any serious complications; all of their pain resolved, and they returned to work and their normal lives.

Can we prevent the formation of a herniated disc? A common cause of herniated discs is aging. However, it is not possible to stop aging. However, there are several factors within your control that can reduce your risk of developing a herniated disc; these include getting support when lifting something heavy, avoiding movements that strain the back, improving your posture, not smoking, choosing healthy foods, maintaining a healthy weight, and exercising.

References:

• American Association of Neurological Surgeons. Herniated Disc. Patient Information Resources.

• Turkish Neurosurgical Society. Lumbar Disc Herniation (Herniated Disc) Diagnosis and Treatment Guidelines.

• National Institute of Neurological Disorders and Stroke. Low Back Pain Fact Sheet.

• National Institute for Health and Care Excellence. Low Back Pain and Sciatica in Over 16s: Assessment and Management (NG59).

• World Federation of Neurosurgical Societies. Guidelines for the Management of Lumbar Disc Herniation.

• Cochrane Collaboration. Surgical versus Non-Surgical Treatment for Lumbar Disc Herniation – Systematic Reviews.