Symptoms

The symptoms caused by a herniated disc depend mainly on the exact location of the prolapse. In addition, the position of the disc in the spinal canal after slippage also plays a decisive role. In a central herniated disc between L5 and S1 without lateral accentuation of the leaked disc tissue, the affected patients describe mainly local back pain.

These back pains typically increase significantly in intensity when the upper body is bent forward. Numbness, tingling or muscle weakness are not to be expected in these cases. On the other hand, a herniated disc between L5 and S1 with lateral accentuation in the spinal canal can cause the nerve roots or individual nerve fibres leaving them to be squeezed.

In this way, the affected patients may experience numbness, tingling, muscle weakness and even paralysis. If the L5 nerve root is compressed, the affected persons typically notice sensory disturbances on the inside of the lower leg, the back of the foot and the big toe. In addition, the lifting of the toes and the abduction of the hips may be limited.

On the other hand, if a herniated disc causes compression of the S1 nerve root, corresponding sensitivity disorders occur in the area of the outer rear lower leg and on the outer edge of the foot. Affected patients also notice a weakness in the rolling of the foot. In the case of a slipped disc in the lumbar spine, it must also be taken into account that, depending on its exact location, the bladder and/or bowel may also be affected.

For this reason, some of the affected patients suffer from urinary and/or fecal incontinence. A slipped disc between L5 and S1 may cause numbness in the dermatome of the nerve root L5. The corresponding dermatome of the nerve root L5 extends over certain areas of the thigh and lower leg.

For this reason, individuals with a herniated disc between L5/S1 may experience numbness and/or pain in the back of the thigh. In addition, the outer side of the knee, as well as the front and side of the lower leg belong to the dermatome of the nerve root L5. If a herniated disc causes numbness, a specialist must be consulted urgently and appropriate treatment initiated.

Otherwise, without therapy, lasting damage to the nerve fibres and a resulting permanent numbness in the dermatome of the nerve root L5 can occur. andIn the case of a pronounced herniated disc between L5 and S1, which leads to severe damage to the corresponding nerve root, impairments of the identifying muscles can be observed in addition to the sensitive failures. Identifying muscles are muscles that are supplied by a specific spinal cord segment and, in the event of a failure, can indicate the location of the damage.

If the motor nerve fibres are damaged by the herniated disc between L5/S1, the function of the extensor hallucus longus muscle (long big toe extensor), the tibialis anterior muscle (anterior tibial muscle) and the gluteus medius muscle (medial gluteus muscle) are particularly affected. Damage to these characteristic muscles means that affected patients can no longer lift the big toe adequately. In addition, impairment of the anterior tibial muscle as one of the L5/S1 identification muscles means that the foot can no longer be adequately turned inwards (so-called supination), spread outwards (adduction) and lifted towards the tip of the nose (dorsal extension).

In the affected persons, a so-called “stepper gait” can be observed due to the damage to the nerve fibres of these characteristic muscles. In case of a herniated disc between L5 and S1, the disc can be pushed out of its normal position in different ways. Patients who experience a shift to the right usually experience similar symptoms.

The shifting of the disc to the right causes severe pain, especially in the area of the buttocks and the right leg. In addition, the sensory disturbances in those affected can also only be perceived on the right side. When standing on tiptoe, the left foot usually remains unaffected, while a discreet foot lifter paresis (slight paralysis of the musculus extensor hallucus longus; long big toe extensor) can be observed on the right.

The right calf muscles can also be affected (S1). However, if the intervertebral disc moves increasingly to the left in a herniated disc between L5/S1, the symptoms occur on the left side. Affected patients typically feel pain in the area of the left buttock and on the left thigh. In addition, the loss of sensitivity affects the dermatome of the nerve root L5 or S1 on the left. Motor deficits are also observed not on the right leg but exclusively on the left.