What is a herniated disc?
The spinal disc is located between the vertebral bodies and serves as a shock absorber. The disc consists of a central, soft, jelly-like tissue, wrapped in a rubber-like annular tissue.
Disc herniation usually occurs as a result of a gradual degeneration process of the disc, which causes a lack of elasticity of the annular tissue, and thus a tendency for this tissue to rupture with a herniation of the internal soft material, sometimes even with a slight effort through rotational movement or bending.
In rare cases, this rupture can occur as a result of high-intensity trauma, such as serious car accidents or falls from a height. The rupture of the soft tissue can cause pressure on the nerve roots and an inflammatory reaction in the area of the rupture. Risk factors for a herniated disc include obesity, engaging in physical work, genetic predisposition, smoking, lack of physical activity and a sedentary lifestyle.
Disc herniation in the lower back
A herniated disc can occur in any area of the spine but the most common area is the lumbar spine (lower back). Lumbar disc herniation is the most common cause of sciatic pain (radiating pain along the lower limb), and it appears in 1 to 5 percent of the population each year.
What are the symptoms of a herniated disc in the lower back?
The initial symptoms include pain along the leg, decreased sensation or numbness of the leg. If the pressure of the herniated disc on the adjacent nerve root is significant, it may also cause weakness of one or more muscles in the leg. A very typical sign of a herniated disc is worsening leg pain while sitting, straining, coughing or sneezing.
Diagnosis and methods of treatment
Diagnosis is made through clinical examination and imaging of the ruptured disc using CT or MRI.
In most cases, the initial treatment is conservative. Uncommon exception is cauda equina syndrome, characterized by a problem in controlling the sphincters, impotence, loss of sensation in the form of a saddle in the groin, or cases of weakness up to paralysis in the lower limbs, then the treatment is urgent surgery .
In the absence of these rare symptoms, the first line of treatment is non-surgical, and includes rest, drug treatment with pain relievers and anti-inflammatories, physical therapy, and root or epidural steroid injections. Studies have shown that about 70 percent of patients suffering from sciatic pain due to lumbar disc herniation report a significant improvement in pain in a period of up to 4 weeks from the onset of symptoms.
In patients who do not respond to the initial conservative treatment, it is possible to consider the continuation of the conservative treatment, or a transition to surgical treatment to remove the herniated disc.
The question "Which patients will benefit from switching to surgical treatment?" has occupied the international spinal community experts for the past three decades and many studies have been published on the subject. These studies showed that the group of patients who were analyzed demonstrated over the years better results in the pain, function and satisfaction indices. Following these studies, the International Association for the Advancement of Spine Surgery recently published a policy proposal for the continuation of surgical treatment in these symptomatic patients who do not improve with conservative treatment. According to this protocol, it is possible to turn to the option of surgical treatment in patients with clinical symptoms of lumbar disc herniation, with confirmation of the herniation through an imaging test (CT or MRI) and without improvement after >6 weeks of conservative treatment.
The surgical treatment can be performed with the classic open approach, using a central back incision above the height of the herniation, removing posterior bone tissue and diverting the nerve sac in order to expose the herniated disc and remove it. Other options include minimally invasive approaches through smaller cuts in the skin, less damage to the muscles adjacent to the spine, thus shortening the rehabilitation process and reducing pain after surgery.