Disc herniation describes the sudden onset of pain as a result of a problem with an intervertebral disc in the spine. Disc herniation is characterised by the sudden onset of pain that can be severe. Lumbar disc herniation describes a disc prolapse in one of the intervertebral discs in the lower back and is often called a ‘slipped disc’. Lumbar disc herniation can cause pain felt in the lower back with numbness, tingling or weakness in the legs.
The spine consists of bones (vertebrae) that are stacked upon one another. Each vertebra is connected to the other by an intervertebral disc. The intervertebral discs help increase the flexibility of the spine and function as shock absorbers. Each individual intervertebral disc consists of a tough outer fibrous layer surrounding a jelly-like inner layer. A disc herniation, or slipped disc, can describe a tear of the outer fibrous layer of the intervertebral disc with or without protrusion of some of the inner gelatinous layer. In a lumbar disc herniation, a tear of the outer fibrous layer can cause significant pain that is usually localised to the lower back. If there is also bulging of the inner gelatinous layer that irritates or compresses one of the nerves around the spine, this can result in significant pain, numbness, weakness or tingling that extends into one or both legs.
Lumbar disc herniation can occur following a specific injury but more commonly occurs as a result of age-related wear and tear. As we age our intervertebral discs become stiffer and so are more at risk of rupturing.
In most instances, the pain from a disc herniation gets better on its own and does not require any treatment. Over 9 out of 10 people with a disc herniation will improve within six weeks.
Very occasionally, if a disc herniation is very large or in certain locations it can cause compression of the spinal cord or certain important nerves such as those that control bowel and bladder function. In these rare instances, more urgent investigation and treatment may be required such as surgery.
If you develop severe neck following an injury you should seek urgent medical attention. If your symptoms have any of the following associated features, you should seek urgent medical attention;
If you do not have any of the above features, you should see your doctor if your symptoms have failed to improve after six weeks or if they are associated with swelling, pain worse at night or recent unintentional weight loss.
The doctor will ask you about your symptoms and examine you. In the absence of any concerning features, you may be given advice regarding exercises to help relieve your symptoms in addition to simple pain medications. You may be referred to a physiotherapist in the first instance, depending upon the local services available. On occasions, depending upon your symptoms and your examination, you may be sent for further investigations which can include blood tests, X-Ray or MRI scans. If you have any concerning symptoms or features on examination, your doctor may send you to the hospital for further investigation and treatment.
In the majority of people with lumbar disc herniation, it gets better without requiring any treatment. If your symptoms do not improve, you may be referred to a spinal surgeon. Further treatments available for disc herniation include injections to relieve your pain or surgery to remove the prolapsed disc.
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