Lumbar Disc Herniation
A lumbar disc herniation is found with disruption of the annulus or tears that allow the inner nucleus to extend beyond the margins of the disc space. Lumbar disc herniation may present as a protrusion or extrusion depending on the shapes. A disc herniation may also be intra-vertebral or within the disc.
This can present with low back pain, sacral pain, buttock pain and possibly leg pain. The pain may be dull, sharp, throbbing or burning. There may also be numbness, tingling, or weakness present in the legs. If severe, neurological findings may be present such as weakness or the inability to urinate or defecate.
A thorough history, physical exam, neurological exam, and imaging studies such as X-rays, MR and CT will help to make a correct diagnosis. A Lumbar disc herniation is best seen on MRI. It is important to be evaluated as soon as possible with new symptoms of leg pain or any neurological findings.
If no neurological deficits are found, this can be treated non-surgically. It can be hard getting through the first 4-6 weeks due to pain and changes in life-style, but remember most disc herniations will improve with time.
Non-surgical treatments usually start with Physical therapy and medications for the first 4-6 weeks. An epidural steroid injection may be indicated if symptoms are not improving.
Physical therapy will work on improving range of motion, correcting muscle imbalances and strengthening the core muscles.
Medications including anti-inflammatories, muscle relaxers and possibly pain relievers will help reduce the swelling, muscle spasms and making progress with physical therapy.
Epidural steroid injections
If there is no significant improvement with physical therapy and anti-inflammatories, a lumbar epidural steroid injection may be indicated. This is a fluoroscopically- guided procedure to deliver steroids at the site of inflammation. It may take more than one to help.
If symptoms such as debilitating pain or neurological findings continue despite non-surgical treatments, it may be time to see a surgeon.