Symptoms of a slipped disc of the lumbar spine

The herniated disc of the lumbar spine (prolapse) is a disease of the spine. The intervertebral disc consists of a fibrous ring (Anulus fibrosus) and the inner core (Nucleus pulposus) and lies as a shock absorber between two vertebral bodies. Due to increasing wear and tear, the gelatinous core loses its original shape, causing the outer fibrous ring to crack.

Parts of the gelatinous core and the fibrous ring can now press on the nerve roots or nerve fibres, which is called nerve root compression. This causes many different symptoms. The type and severity of the symptoms depend on the height of the spinal column at which the herniated disc occurs.

Most herniated discs occur at the level of the lumbar spine. Accordingly, corresponding symptoms develop that particularly affect the back and lower extremities. – Intervertebral disc -Discus inter vertebralis

  • Gelatinous core – nucleus pulposus
  • Fiber ring – Anulus fibrosus
  • Spinal nerve – N. spinalis
  • Spinal cord – Medula spinalis
  • Spinous process – Processus spinosus
  • Transverse process -Processus transversus
  • Superior articular process – superior articular process
  • Intervertebral hole -Foramen intervertebrale
  • Vertebral body – Corpus vertebrae
  • Anterior longitudinal ligament -Lig.

longitudinal anterius

The herniated disc L5/S1 describes the height of the prolapse between the fifth lumbar vertebra and the first coccygeal vertebra. This area is located at the spinal column in the lower spine. This is where most of the body’s load is often borne, which is why the vertebral bodies wear out quickly and the herniated discs therefore become more frequent.

A prolapse there is also called a lumbar vertebral disc herniation. This height is often named after a nerve that runs in the vicinity, the sciatica. Typical symptoms for a herniated disc at this height is a sudden shooting pain, which is called sciatica because of the large nerve there.

The pain extends from the injured area especially into the lower back. Depending on how much the spinal nerves are pinched by the bulging of the gelatinous core, the pain can also radiate into the legs. Patients often report symptoms such as sudden pulling and shooting pain that extends from the back to the legs.

The pain is often localised more precisely and is located on the thigh and calf. In addition to pain, these skin areas can also be affected by sensitivity disorders. This means that the patient can no longer feel a touch there.

In the field of anatomy and neurology, the term “identification muscles” refers to muscles that are innervated by a specific individual segment of the spinal column. The nerve fibres emerging from this spinal ganglion are responsible for the function of certain muscles. A very important role is assigned to these characteristic muscles, because their loss of function due to spinal column injuries as well as in the case of herniated discs gives an indication of the height of the spinal column at which the injury is located.

The symptoms can be used to draw conclusions in the course of various examinations. The clinical examination therefore shows a loss of muscle function. This means that the patient is no longer able to perform a certain movement, or that a clear muscle weakness becomes apparent.

In addition, certain reflexes can no longer be triggered due to the damage. The characteristic muscle for the lumbar vertebral body segment 5 is the extensor of the big toe (Musculus extensor hallucis longus). If this segment is damaged, the patient is no longer able to consciously extend the big toe, depending on the severity of the injury.

The physician can additionally test the function of this nerve path with the Tibialis-Posterior Reflex (TPR). To do this, the doctor taps the corresponding tendon of the muscle with a special reflex hammer on the inside of the foot below the protruding ankle. On the slight tap, an internal rotation (supination) of the foot and also the extension of the big toe is revealed.

If there is pronounced damage to the nerve tract and thus the characteristic muscle, this reflex cannot be triggered. The identification muscle for the vertebral body segment S1 is one of the superficial lying calf muscles, the muscle triceps surae. This muscle consists of three submuscles, all of which have their common point of attachment at the Achilles tendon.

This muscle causes a flexion of the foot towards the sole of the foot (plantar flexion). The Achilles tendon reflex can be used to check the nerve path. To do this, the doctor taps the Achilles tendon with the reflex hammer.

In a healthy person, the foot would bend down. If there is a herniated disc, it is possible that the movement stops when the Achilles tendon is hit. According to this, the doctor may suspect a damage in the corresponding segment.

  • How do I distinguish a herniated disc from a lumbago? Slipped disc – Nucleus pulposus prolapse A – Slipped disc from the left B – Slipped disc from above C – Healthy slipped disc a – Cervical and thoracic area b – Lumbar area
  • Fiber ring – Anulus fibrosus
  • Gelatinous core – nucleus pulposus1. + 2nd intervertebral disc (intervertebral disc) – Discus inter vertebralis
  • Spinal nerve – N. spinalis
  • Spinal cord – Medula spinalis
  • Vertebral body – Corpus vertebrae
  • Spinous process – Processus spinosus

The designation L4/L5 refers to the lumbar vertebrae four and five and the intervertebral disc between them.

If a herniated disc occurs at this height of the spine, the nerve bundles and spinal root located there can be affected. If a herniated disc L4/5 occurs, the 4 and 5 nerve roots of the lumbar spine can be damaged. These are responsible for specific movements in the leg and the sensitive innervation of certain areas of skin.

Thus, an injury at the level of L4 can result in sensory disturbances on the outside of the thigh, the patella and the inside of the lower leg. This means that the patient may no longer feel a touch there as a symptom, or numbness and tingling may occur due to the herniated disc of the skin. Furthermore, the loss of various movements can also occur as a symptom.

Since L4 is also responsible for the quadriceps femoris muscle, it can happen that the knee can no longer be stretched properly due to the damage and lifting the foot can also be limited. The physician can also test the loss of function through the patellar tendon reflex. To do this, the doctor taps with the reflex hammer below the kneecap on the tendon running there.

If the reflex is intact, the loosely hanging leg springs forward, if there is nerve damage, this movement is absent or significantly weakened. In the case of damage to the nerves from L5, the symptoms of the herniated disc are disturbances in sensitivity on the inside of the thigh, the back of the foot and the big toes. The disorder can also manifest itself here as numbness or tingling.

If there is pronounced damage to this segment, a loss of function of the toe lifter may occur, which typically corresponds to a large herniated disc L4/5. Pain is felt by every affected person and therefore it belongs to every herniated disc. Usually the pain has a stabbing quality.

In addition to the pain, sensations can be noticeable. These include, among other things, tingling or numbness. In severe cases, muscle paralysis – mainly on the thighs – can also occur.