Diagnosis

The diagnosis of a suspected herniated disc between L5/S1 usually comprises several steps. First of all, a detailed doctor-patient conversation (anamnesis) should help to narrow down the possible existing diseases. During this conversation, the affected patient should describe the symptoms he/she has observed as precisely as possible.

In addition, different life habits (for example, sporting activities), the job and existing previous illnesses play a decisive role in this doctor-patient conversation. An orienting neurological examination should then be carried out. By checking the sensitivity in the skin areas assigned to the individual nerve segments, it is possible to roughly estimate whether a herniated disc is present and at what level the change is located.

In addition to the sensitivity test, reflexes and muscle strength should also be tested. If there is evidence of impairment of the nerve fibres, the nerve conduction velocity should also be measured. Since various internal diseases can cause symptoms similar to those of a slipped disc between L5 and S1, the most important pulse points on both legs must also be checked.

In this way, circulatory disorders of the legs (e.g. the so-called “peripheral arterial occlusive disease, or pavK” for short) can be excluded. If the suspicion of the presence of a herniated disc between L5 and S1 is confirmed in the course of the diagnosis, imaging procedures must be ordered. Especially the preparation of x-rays in different postures plays a decisive role in the diagnosis of a herniated disc between L5/S1.

A disadvantage of conventional radiographs, however, is the fact that in this way only the bony vertebral bodies with any signs of wear can be assessed. The disc itself cannot be assessed in these functional images. For this reason, if the presence of a herniated disc between L5/S1 is suspected, an additional magnetic resonance imaging (MRI), computed tomography (CT) or so-called myelography should be performed. With the help of these imaging procedures, the spinal cord and nerve fibres can also be displayed and assessed. The imaging of these structures can be further improved by the administration of a special contrast medium.

Therapy

The choice of the most appropriate treatment strategy for a herniated disc between L5/S1 depends mainly on its extent and the existing symptoms. If the herniated disc between L5 and S1 is diagnosed early, a conservative (non-surgical) therapy usually follows first. If the symptoms perceived by the affected patient do not improve within a period of six to eight weeks, an alternative treatment strategy should be considered.

The non-operative treatment for a herniated disc between L5/S1 includes above all physical rest, adequate pain therapy and the change of risky living habits. In case of acute pain, the spine should be immobilised if possible. However, absolute bed rest over a longer period of time can have a negative effect on the healing process.

For this reason, the affected patient should always be advised to engage in sports that are gentle on the spine. Swimming is particularly suitable for alleviating the symptoms. In many cases, drugs that serve to relax the muscles can also be used successfully.

Surgical treatment should also only be considered for a herniated disc between L5/S1 if other therapeutic measures do not show the desired success. Furthermore, pronounced impairments of the sensitive or motor nerve conduction can be the reason for surgical treatment. If a herniated disc between L5/S1 is diagnosed early, a purely conservative therapy is in most cases completely sufficient.

In general, it can be assumed that about 90 percent of the affected patients respond well to conservative therapy and do not require surgery. However, conservative therapy should show initial success after a period of three to four months, otherwise the treatment strategy must be urgently reconsidered. Protection of the affected spinal column section plays a decisive role in conservative therapy.

In addition, the patient should be encouraged to strengthen the back muscles in the course of special physiotherapy in order to counteract the changes in the lumbar spine. Whether an outpatient physiotherapeutic therapy is sufficient or whether an inpatient rehabilitation must be carried out should be decided on a case-by-case basis. Acute pain, which occurs with a herniated disc between L5/S1, can be relieved in the course of conservative therapy with locally applied heat.

Special ointments and plasters are particularly suitable for conservative therapy in the case of a herniated disc between L5/S1. In addition, affected patients in the acute pain phase should take pain-relieving medication according to a fixed schedule. However, the most suitable medication for the symptoms and the dosage regimen adapted to the affected patient should be urgently discussed with a specialist.

An increase in symptoms under conservative therapy or particularly pronounced paralysis at diagnosis may make immediate surgery for the herniated disc necessary. Especially in case of a fresh or less pronounced herniated disc between L5/S1, conservative treatment methods, such as special exercises and physiotherapy, can be helpful. The first therapy attempts for a herniated disc between L5/S1 should primarily serve to alleviate the acute pain symptoms.

In addition, the stability of the spine should definitely be increased by special exercises and physiotherapy. Especially exercises that serve to build up the back muscles can help to improve the symptoms within a very short time. However, in the case of a slipped disc between L5/S1, the exercises should only be learned under the supervision of a specialist.

Incorrectly performed exercises could otherwise cause permanent damage to the spine. In addition, when conservatively treating a herniated disc between L5/S1 (for example, with the help of physiotherapy), it must be noted that an initial improvement of the symptoms should occur within a few weeks. If this is not the case, other treatment methods must be urgently considered.

Surgery is always considered for a herniated disc between L5 and S1 if conservative treatment measures are not effective or if there is a risk of nerve damage. Especially in patients who observe loss of sensitivity or motor deficits in the course of a herniated disc between L5/S1, surgery should be considered. In general, the indication for surgery in the presence of a herniated disc is now only very cautiously considered.

In addition, it should be noted that due to the enormous risks of an open surgical procedure, is now almost exclusively treated by so-called minimally invasive procedures. With the help of minimally invasive procedures, which under certain circumstances can also be performed under local anesthesia, it is not possible to treat advanced herniated discs between L5 and S1. Especially the so-called “chemonucleosis”, in which the inner gelatinous ring of the intervertebral disc is liquefied with chemical agents and then suctioned off, has become a standard procedure.

In addition, surgery with the laser can be useful for a fresh herniated disc between L5/S1. In this procedure, the displaced disc must be removed with the laser. In this way, the pressure on the nerve fibres can be reduced or completely removed.

Another and particularly popular surgical method for a herniated disc between L5/S1 is the so-called “percutaneous nucleotomy”. In this method, the excess volume of the gelatinous core is sucked out through the skin. Chemical substances are not used in this operation.

Advanced herniated discs between L5/S1, however, usually require conventional open surgery. This often applies to a herniated disc between L5/S1, which has already caused pronounced sensitive or motor deficits. In open disc surgery, a large skin incision must be made and the affected vertebral segment exposed. For this reason, inflammation or wound healing disorders may occur after the operation. However, these possible complications can usually be easily treated in inpatient care.