Dr. Leipzig is a board-certified, Salem, Virginia spine surgeon with over two decades of experience. He specializes in procedures including robotic spine surgery, microsurgical lumbar surgery, disc arthroplasty, minimally invasive spine surgery, and more, serving the greater Roanoke, VA area. To learn more or schedule an appointment, please contact our office.
Our spine is responsible for a lot of our daily movement, such as arching, bending and twisting. When a disc herniates, it can pinch a nerve and cause buttock or leg pain (sciatica). Although a herniated disc can occur anywhere along the spine, it most often happens within the five vertebrae that make up the lower back: the lumbar spine. Previously, we explored symptoms of a herniated lumbar disc, such as sciatica, numbness and tingling, muscle weakness, and even loss of bladder or bowel control. Some individuals with disc herniation can also have no symptoms, even when the condition is identified on imaging.
Let’s briefly review how spinal discs work. Each spinal disc consists of a hard, outer ring (annulus fibrosus) and soft interior (nucleus pulposus), which absorbs shock between vertebrae to minimize impact from movement. A disc’s spongy interior pushes against the rigid outer ring and creates pressure. When this pressure forces the outer ring to bulge or rupture, it places strain on the spinal cord and nearby nerves, and can cause pain. Several risk factors can combine to create a perfect storm for lumbar disc herniation: disc degeneration form normal age-related wear and tear, smoking, being overweight and poor physical conditioning.
Once clinically diagnosed with a herniated disc (by a medical professional reviewing your symptoms, examining you, and sometimes with MRI or CT imaging to confirm or rule out other conditions), managing the condition comes next. Symptoms from a herniated lumbar disc can often resolve on their own from weeks to months with such conservative management as:
- Heat/Ice – Try using a heating pad (or single-use heat wrap) on a low or medium setting for 15-20 minutes every 3 hours. You can also try an ice pack for up to 15 minutes every 2 to 3 hours.
- Clinically directed exercise – Do the exercises recommended by your doctor or physical therapist to help keep your back muscles strong and prevent further injury.
- Rest for a day or two in cases of severe pain.
- Medications – Medicine will not resolve a herniated disc, but it can relieve some associated pain or muscle spasms and inflammation. Your doctor can make recommendations if indicated, such as acetaminophen, NSAIDs (e.g., ibuprofen), muscle relaxers, or even steroid injections.
The Case for Surgery
Most people with a herniated disc will improve without surgery. Approximately 90% of people will improve within 6-8 weeks of the onset of sympotms. When conservative treatment fails, meaning if your symptoms don’t get better after few months, or if you have one or more ‘red flag’ symptoms which require surgery (such as progressive numbness, weakness or bladder or bowel control changes), you may want to discuss surgical options with your doctor. Disc surgery isn’t a treatment for low back pain that’s not caused by a herniated disc; it’s also not ideal if back pain is the only symptom the herniated disc causes. When tests show that your herniated disc can be treated surgically, your pain/nerve damage has not improved over time, your symptoms prohibit you from doing normal activities, and you feel damage worsening, more weakness, or loss of feeling or coordination, it’s worth looking at surgical options.
In my practice, we emphasize minimally-invasive and microsurgical techniques. Advanced minimally-invasive techniques have made surgery safer and less invasive than ever before. During a microsurgical discectomy, which is an outpatient procedure, we remove portions of the herniated lumbar disc to relieve pressure on the spinal nerve root. Microsurgical discectomy may be the most effective type of surgery for people who have unsuccessfully tried nonsurgical treatment and endure severe, disabling leg pain. Another procedure is mircorsurgical lumbar laminectomy, or laminoplasty, a minimally-invasive technique for decompressing pinched nerves in cases of spinal stenosis. Pinched or compressed lumbar nerves are not exclusively the result of herniated discs; they can also stem from conditions such as spinal stenosis or spondylolisthesis, which we can also surgically treat with minimally-invasive procedures.
Patients with herniated lumbar discs who chose surgery may experience a faster recovery, but both surgical and nonsurgical patients eventually show similar long-term abilities to work and to be active. Many people are able to resume work and daily activities relatively soon after surgery. In most cases, you can expect post-surgical home exercises and/or physical therapy.
If you are looking for strategies to manage your herniated lumbar disc or are concerned about disc herniation symptoms and seek a proper diagnosis, contact our spine care office today to schedule an appointment.