A slipped disc of the lumbar spine (lumbar spine) can be treated in different ways. The therapy depends on the symptoms of the patient, the severity of the herniated disc as well as the age and general condition of the person affected. Basically, a distinction can be made between conservative and surgical therapy.
In most cases, good long-term success can be achieved with conservative measures. Surgery is only performed in cases of absolute urgency, since the complication and relapse rates are relatively high. Patients can benefit from a wide range of therapeutic options – for example, physiotherapy, pain therapy and heat treatment. If conservative measures do not lead to success, an operation can be considered.
Causes
A herniated disc of the lumbar spine results in a gelatinous mass emerging from an intervertebral disc. The intervertebral discs consist of a kind of fibrous ring inside which there is a gelatinous substance. If this ring tears or leaks at one point, the interior of the disc can swell and press on nearby nerves or the spinal cord.
Depending on the location, this then causes typical symptoms. In most cases, a herniated disc occurs when the affected person makes a jerky movement or lifts heavy objects. The disc is often already pre-damaged by fine cracks and then tears due to the abrupt movement. Today’s lack of exercise, weak back muscles and overweight make herniated discs more likely. Most frequently, the intervertebral discs between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra are affected.
Symptoms
The symptoms caused by a lumbar disc herniation vary depending on the location of the herniation. If the herniated disc presses on the centre of the spinal cord, localised back pain can occur, which increases especially when prevented. If the gelatinous core of the intervertebral disc emerges laterally, it often presses on the nerve roots that emerge from the spinal cord between the vertebrae.
If such a nerve is squeezed, pain occurs, which radiates into the supply area of the respective nerve. In the case of the lumbar spine, therefore, pain often occurs that extends into the leg. Numbness, tingling and other sensations can also occur.
Large herniated discs can also lead to paralysis. The worst case occurs when a so-called mass prolapse (a very large herniated disc) almost completely displaces the spinal canal. The affected patients then lose the ability to control the bladder and intestines, suffer from paralysis and often severe pain. In such a case, surgery must be performed as soon as possible.
Diagnostics
To diagnose a herniated disc of the lumbar spine, the clinical symptoms of the patient are groundbreaking. A neurologist collects the patient’s symptoms in a conversation and then conducts a thorough physical examination. If the findings suggest that it could be a herniated disc, additional imaging procedures are used.
In the magnetic resonance tomograph of the lumbar spine (MRI), the jelly-like mass swelling from the intervertebral disc is visible. The doctor can determine how and where it is pressing on the spinal cord or spinal nerves. Computer tomography (CT) can also be used to visualise a herniated disc.
Ultimately, however, the images produced and the extent of the herniated disc visible there must always be interpreted in conjunction with the patient’s symptoms. It is not uncommon for MRI of the lumbar spine or CT to reveal random findings in which an intervertebral disc presumably presses on the spinal cord, but the patient has no complaints. Then no therapy is necessary.
