Lumbar Disc Herniation
What you need to know
The disc is the material lying between the two bones which acts as a cushion and shock absorber which distributes stress when a compressive force is placed on it. Sometimes as the disc wears out from aging or in severe causes from trauma, the outer part of the disc called the annulus weakens and develops a tear whereby the inner jelly can rupture and pass through placing abnormal pressure on the spinal nerves.
Most often, the herniation produces pain down the legs, and in severe cases can cause numbness and weakness. This is termed a radiculopathy. In seldom cases, the herniation is so big that it compresses the nerves to the bowel and bladder, which causes bowel and bladder incontinence, termed cauda equina syndrome.
The imaging test of choice is a MRI which can directly assess the location and severity of the herniation within the spinal canal. Most herniations can successfully be treated with non-steroidals, rest, and physical therapy. In patients who do not respond to these initial modalities, an epidural can be performed to alleviate leg pain. If in the event all fails or if there is neurological weakness, a lumbar microdiscectomy or lumbar laminectomy can be performed.
Most patients do not need urgent surgery and try numerous non operative treatments to resolve the pain. These include anti-inflammatories, nerve pain pills, muscle relaxants, rest and physical therapy. If these options fail, an epidural steroid injection can be performed to provide relief.
If conservative treatments fail, there are several surgical solutions that can be performed. These include removal of the disc herniation to take the pressure of the nerves and spinal cord, which is commonly either a fusion procedure or a disc replacement.
Patrick J. Horan, MD, MBA, FACS
Patrick J. Horan is an orthopaedic surgeon and sports medicine specialist with two decades of experience. He is board-certified in orthopaedic surgery and sports medicine. After receiving his undergraduate degree from Duke University in Durham, N.C., Dr. Horan earned his medical degree from Tufts University School of Medicine in Boston. Residency and Internship were both completed at Walter Reed Army Medical Center in Washington, D.C. He also received an MBA from Auburn University in Auburn, Ala.
Dr. Horan served 10 years on active duty in the US Army as an orthopaedic surgeon before entering into private practice. Dr. Horan is the founder of the Westchase Orthopaedic and Rehabilitation and the official surgeon of the Tampa Bay Rowdies. He maintains professional memberships with the American Academy of Orthopaedic Surgeons, the American Academy of Orthopaedic Sports Medicine and the Arthroscopy Association of North America.
Tampa’s Top Doctors!