Lumbar disc herniated disc (in the lower back) animation

What are the symptoms of a herniated disc?

LEG PAIN:

With a disc herniation hernia there is often radiating pain in the buttock and leg. The complaints are then only present in one leg. The radiation is sometimes preceded by a short period of sudden severe back pain. Most complaints of a disc herniated disc are in the leg. The place where the pain appears depends on which nerve is pinched in the back. There is a big difference between pure back pain and back pain with radiation to the leg. The radiation to the leg is called 'sciatica'. The pain increases when one coughs, sneezes or squeezes.

The severity of the symptoms depends on how much pressure the disc herniation causes to the nerve. In addition to leg pain, reduced strength in the leg and sensory disturbances such as tingling, burning or deafness can also be caused by a disc herniation. In extremely large disc herniations, the irradiation may be present in both legs and there may be loss of urine or bowel control. 

Back pain:

A typical story of a patient with complaints caused by a disc herniation is the development of sudden severe back pain that disappears spontaneously and often completely after a week. In the following weeks the radiating pain (to the buttocks, hip, thigh, calf, foot) develops. 

The back pain in a disc herniation is usually not directly caused by the discus disorder but by the cramping of the back muscles.

What is a herniated disc?

how does the herniated disc develop?

Between the vertebrae there is an intervertebral disc. Its main function is to absorb movement and shocks like a "shock absorber". This disc consists of an outer ring ("annulus fibrosus", often called "annulus") containing a kind of soft core ("nucleus pulposus") consisting of jelly-like tissue. A disc herniation is caused by a tear in the outer ring where the nucleus can escape from the disc through this opening in the annulus. 

What If the disc herniation Compresses a nerve?

If an annulair tear occurs in the outer ring, back pain occurs. If the tear is large enough, gel escapes from the disc as well. Only then is there a hernia. If this hernia also bulges out at a place where it also 'accidentally' compresses a nerve, sciatica, the typical leg pain, occurs. 

What If the disc herniation does NOT Compress a nerve?

A herniation can also protrude without compressing a nerve. Then there is only back pain, which usually disappears spontaneously after about ten days. This is why we often see disc herniations on a scanner, without any back problems. These 'gentle' hernias can be regarded as a normal aging process and are usually only responsible for a more sensitive back.  

Do I have a DISK herniaTION or a bulging (disc) ?

Another form of discus wear is the "bulging disc". In case of bulging or "bulging" of the shock absorber, there is a wide generalized bulge of discus. With every movement of the back, the moving disc will bulge a little (Eng: "to bulge").

A bulging disc is also very common and can to some extent be regarded as a normal wear and tear process of the back. This bulging occurs slowly and usually does not oppress the nerves. They are, if at all, a cause of episodic back pain, they do not give rise to leg pain. Rather rarely, bulging is the origin of the hernia. A very large bulging can cause a narrowing of the spinal canal.

However, the bulging and herniated discs that do not compress nerves can be seen on scanners.

Not that all disc herniations cause symptoms. Usually these radiological findings can be regarded as an 'accidental find' on imaging. Almost 70% of the people do have one or more non-compressive disk herniations or bulging disks, without having any back problems.  

What are the causes of a herniated disc?

• A congenital weakness of the intervertebral disc tissue. This means that in some families back problems occur more often and already at a younger age. Smoking causes accelerated wear and tear of the intervertebral discs.

• Smoking increases the chance of developing a herniated disc and also makes it more difficult to heal.

• Lack of exercise weakens the trunk muscles. These muscles are the 'active' shock absorbers that release the 'passive' shock absorber from the disc. In the absence of call muscles, the disc must absorb all forces and is therefore more sensitive to injuries.

A continuous overload in combination with the natural aging process causes the intervertebral discs to show signs of wear and tear. The pressure on the back is greatest at the level of the lower intervertebral discs, which is why hernias occur most frequently on the two lower links of the back. Therefore, 90% of all hernias occur between L4 and L5 or L5 and S1. 

When the disc is weakened, sudden twisting or increased load can cause a herniated disc. A violent cough or sneeze can also cause an acute herniated disk 

Between the age of 20 and 40 there is a higher risk for development of a herniated disc. At a later age, the jelly of the nucleus becomes too dry and stiff to be able to slip through a crack in the outer ring. 

What are the possible treatments?  

The treatment is at first almost always 'conservative', which means as much as therapy without surgery. An attempt is made to help reduce or eliminate the pain symptoms as quickly as possible.  The most important first target of this therapy are the complaints in the leg. After thorough examination of the patient, a treatment plan is drawn up. Often the first therapy is a combination of medication and continued normal activities. Resting is not a treatment for back related complaints. It may be beneficial because the muscles relax, but it has been scientifically proven that this only weakens the trunk muscles. The back then weakens instead of healing. 

Taking sufficient pain medication, keeping moving and picking up normal life as soon as possible is the best advice. 

With some people the pain doesn't diminish or the symptoms are too severe. Then transforaminal infiltrations can be prescribed. Under local anaesthesia a cocktail of analgesic and anti-inflammatory drugs is injected through the lateral ventricles (the "foramina"). The aim of this is to cause the hernia and nerve to swell, so that the pinching of the leg nerve and thus the leg pain disappears. Usually, two transforaminal infiltrations are given over a period of three weeks. These infiltrations are carried out in our centre by experienced anaesthetist-algologists. They require a short hospital stay of two hours. If necessary, they can be organised at relatively short notice by the referring specialist. 

If these treatments do not help or in case of paralysis symptoms, it is sometimes decided that an operation becomes necessary. In our department they are extremely minimally invasive. By means of a keyhole surgery of the back: the full endoscopic lumbar discectomy can efficiently treat the various causes of leg pain in the back. These are the least invasive procedures possible, which efficiently remove the hernia without collateral tissue damage.