| Definitions: Lumbar Herniated Disc |
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Definition Herniated disc means displacement of the nucleus from its normal position within the boundaries of its outer fibrous ring (the annulus). The disc structure is composed of the soft centered nucleus and the outer fibrous ring (the annulus). The disc structure is positioned in between the vertebra. Herniations commonly occur posteriorly (towards the back of the body) due to a thinner boundary. The spinal nerves and dura (fluid filled sac containing the nerves) are located behind the disc structure in the lumbar spine. Diagnosis The diagnosis is made from the history, physical exam performed by the doctor and diagnostic imaging studies (MRI, Myelogram, Contrast CAT Scan). If the herniation puts pressure on the spinal nerve or nerves, then the patient may complain of pain, numbness, or weakness in the leg. The symptoms may be in one leg or both legs depending on the location of the herniation. Rarely, a disc herniation may interrupt the nerve function of the bowel and bladder. Non-Surgery Treatment Non-operative treatments include the following: restriction of activity, physical therapy, medications, alternative medicine, epidural steroid injections, etc. Surgical Treatment Surgery is indicated for loss of bowel and bladder control, progressive weakness in the leg or legs or unacceptable pain in the leg or legs. The surgical concept is simple: remove the herniated disc and thus free the nerve from pressure caused by the herniation. Prognosis Many patients with herniated discs in the lumbar spine improve without surgery. In those patients who have surgery, prognosis is influenced by the duration of their symptoms. |