What Is Lumbar Herniated Disc?
The lumbar spine is composed of five vertebral bodies interest posed with shock-absorbing discs.
The disc is a remarkable structure, can absorb and release water, and remains hydrated, allowing shock-absorbing forces in the lumbar spine to dissipate.
As we age, the natural progression of lumbar discs is to degenerate gradually. Some conditions cause excessive degeneration, such as smoking, morbid obesity, an entry lifestyle, certain occupations, and trauma.
The outermost part of the disc is called the annulus, a thick fibrous ring, and the innermost part is the nucleus pulposus, wishes a little more spongy. Some have described the consistency of the nucleus as similar to crab meat. A disc bulge refers to a gradual weakening of the outer fibers allowing the center nucleus to push outwards; however, the nucleus does not break through the outer annulus. On the other hand, disc herniation is described when the center nucleus pushes its way through weakened annular fibers, usually in the back or posteriorly, and a portion of it is outside of the annulus. This can occur with or without symptoms.
The center of the disc is also rich in a substance called phospholipase A2, a prostaglandin that can elicit a severe inflammatory reaction. Because the nucleus pulposus is not exposed to the rest of the developing fetus during embryonic development, it remains a potent antigen. Therefore herniated discs can lead to a severe inflammatory reaction that can spill over onto the adjacent nerve root on either side. Symptoms of a herniated disc can range from low back pain to radiation or radicular pain traveling down the distribution of these nerve roots.
If a piece of the disc breaks away from the center, it is called a sequestrated herniated disc fragment.
Treatment of herniated discs depends on the physical examination.
Conservative management, such as physical therapy, acupuncture, lumbar stabilization, core strengthening exercises, anti-inflammatory medication, and antiepileptic medication for radicular pain, should all be tried. If the herniated disc is causing symptoms that persisted despite the above conservative measures, steroids along the nerve root and in the epidural space can help reduce the inflammation and allow improved blood flow back to the nerve.
Surgical intervention may be required in severe cases or when there is a significant functional component called a neurological deficit. Surgeries can range from removal of a small amount of disc material only, either with an open exposed technique or, more recently, through small cameras or endoscopic techniques. Severely herniated discs accompanied by severe degeneration and loss of height of the disc may require a disc replacement or a fusion using hardware.
