Lumbar Disc Disease

Lumbar disc disorder can happen as people get older and the discs start to dry out, or it can happen if there is a severe trauma that causes one of the discs to collapse, explode, or herniate [HER-nee-ate]. It affects the discs of the lower spine, above the hips and tailbone area, but below the ribs.

As the discs either dry out due to age or are weakened due to trauma, sometimes the disc can collapse or compress. This may cause it to lose its shape and bulge out from in-between the vertebrae. Sometimes the disc can also rupture, which makes it lose its shape. A bulging or ruptured (also called herniated) disc can press on the nerves in the spinal column, which can be very painful.

Your spine is made up of vertebrae [VER-tih-bruh], discs, spinal cord and nerves, ligaments, and muscles. Your vertebrae are stacked up on top of each other. The spinal column is divided into 4 regions with the vertebrae in the lumbar [LUM-bar] spine (the lower back area) including 5 vertebrae, which are numbered from L1 to L5. Each of these vertebrae are separated by discs that help cushion the vertebrae from the other vertebrae or bones above and below it.

Back pain is common. Most pain is temporary, but it can reoccur. It’s often caused by a strained muscle or sprained ligament — perhaps from an activity you’re not used to, such as yard work, moving furniture, or sitting for a long time. 

Less often, pain happens when part of your spine is injured or from a condition you were born with or may have developed with age. The pain may accompany other symptoms such as stiffness, numbness, or weakness in your arms and legs. Spine problems can even affect your bowels and bladder. 

Although lumbar disc disease can be very painful, pain is not the only symptom. The symptoms of lumbar disc disease vary depending on the disc that is affected and which nerve the disc may be pushing on. Other symptoms of lumbar disc disease may include:

• Numbness, tingling, “pins and needles” 
• Bowel or bladder problems 
• Stress or emotional issues 
• Fever, chills, sweating 
• Weakness or slow reflexes 
• Dizziness, headaches 
• Sexual dysfunction 
• Unusual weight gain or loss 
• Back muscle spasms
• Sciatica [sie-AT-ick-uh] — pain near the back or buttock that may become so intense that it travels down the leg to the calf or foot

Anyone can have back pain. Still, some things increase your chance of having lumbar disc disease, such as:

• Aging. The older you are, the more likely you are to have back pain. 

• Poor physical fitness. Lack of exercise and poor posture increase your risk of back pain. 
• Being overweight. Extra weight puts extra stress on your spine. 
• Your job or your hobby. A job or activity that requires you to lift, push, or pull can be risky. But desk work can also be hard on your back, especially if you don’t sit up straight or don’t get up very often. 
• Smoking. Studies show that smokers have more back pain and spinal conditions than non-smokers. 
• Previous injury. An injury you had months or years ago may put you at risk for back problems as you age. 
• Diseases. Arthritis [ahr-THRAHY-tis], osteoporosis [os-tee-oh-puh-ROH-sis], and other diseases can increase your chance of having back pain. 
• Family history and genetics. Some conditions run in families. 

To learn about you and your condition, your doctor will talk to you about your symptoms with you, examine you, and run some tests. Over the course of your care, this process may be repeated as part of follow-up care or as other doctors help care for you. Some tests your doctor may use to diagnose lumbar disc disease include:

• Lab Tests. Sometimes, back and neck symptoms can be caused, or made worse, by an illness in your whole body, not just in your spine. To check for illness, your doctor may take a sample of your blood or urine. If surgery or other interventions will be part of your treatment, lab tests are often ordered first. 
• Imaging studies. There are several tools that allow your doctor to take pictures of the inside of your body. Depending on what they need to see, they may suggest one of the imaging studies listed below:
• X-ray. This test uses beams of low-dose radiation to create pictures of tissues, bones, and organs on film. 
• MRI. Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to create images. MRI is very useful for evaluating details of soft-tissue structures and the nerves in and around your spine. 
• CT scan. Computed tomography (CT) uses a computer and x-rays to create cross-section views (“slices”) of areas of the body. It’s especially useful for highlighting abnormal tissue and clearly showing bone detail.
• Bone density scan. This scan uses x-ray or ultrasound to measure the amount of bone in a particular area. It can detect and assess osteoporosis (thinning bones). 

Your care may include one or more of these treatments: 

• Education and activity. Your doctor can teach you what you can do on your own to relieve pain, regain strength, and increase flexibility. For example, your doctor may advise you on proper body mechanics (how to sit, sleep, lift, and so on) or how to use ice and heat to ease inflammation. Much of this important education can help you prevent spine pain in the future as well as treat it today. 
• Oral medication (pills).  Your doctor may prescribe medicine to reduce inflammation, relax muscles, and ease pain. Take the medicine exactly as your doctor or pharmacist advises, and let your doctor know about other medicines you take including over-the-counter medicines, supplements, inhalers, liquid medicines, and patches. 
• Physical therapy. Physical therapy encompasses a variety of treatments to promote healing, relieve pain, build strength and flexibility, and help prevent future injuries. For example, your physical therapist may create and supervise a program of exercises and make suggestions to help improve body mechanics (how to sit, sleep, lift, and move). Other physical therapies include spinal manipulation (applying force to a spinal joint) and traction. 
• Traction. Traction is a non-surgical method for decompressing the vertebrae. It’s done either manually (by a specially-trained provider) or mechanically with braces or devices that gently elongate the spine. 
• Spinal injection. Your doctor may recommend a spinal injection to treat inflammation or ease pain. An injection can deliver medication directly to the source of your symptoms. Common injections include: 

 

• Epidural steroid (cortisone) injections. Injections near specific nerves or directly into the epidural space (the area around the nerves within the spinal canal) can help diagnose and treat pain. 
• Facet joint injections and nerve branch blocks. Injections in or near the facet joints can treat arthritic joint pain. 
• Sacroiliac (SI) joint injections. Injections at the SI joint, where the spine and pelvis join, can diagnose and treat pain in that area. 
• Trigger point injections. Injections into tight, irritated muscle areas (trigger points) may help the muscle relax and ease pain. 

   

• Other non-surgical procedures. Other procedures, such as neurotomy and radiofrequency ablation, use heat, cold, chemicals, or radiofrequency energy to destroy nerves near a problem joint. This relieves symptoms by preventing pain signals from traveling to the brain.  Additional treatments for chronic pain include spinal pumps and stimulators that are implanted under the skin. A pump can put medication directly into the spinal fluid at just the right place in your spine. A spinal stimulator delivers a small electric pulse on the surface of the spinal cord to help mask pain. 

  Additional treatments for chronic pain include spinal pumps and stimulators that are implanted under the skin. A pump can put medication directly into the spinal fluid at just the right place in your spine. A spinal stimulator delivers a small electric pulse on the surface of the spinal cord to help mask pain.

• Surgery. Most spine problems can be treated without surgery. In some cases, however, your doctor may suggest surgery as a good option for relieving your symptoms. Surgical options include those listed below:  
• Microdiscectomy [my-crow-disk-EK-tuh-mee]. Removing part of a damaged spinal disc through a small surgical incision, using microscopically enhanced techniques. 
• Laminotomy [lam-in-Ah-tuh-mee]. Taking out bone, ligament, and spurs that cause spinal stenosis. These procedures reduce pressure on a nerve or the spinal cord. 
• Spinal fusion [FEW-shun]. Joining (fusing) 2 vertebrae so that there’s no movement between them. 
• Anterior Cervical Discectomy [disk-EK-tuh-mee] and Fusion (ACDF). Removing a disc in the neck (cervical) region of your spine and fusing the vertebrae above and below it. 
• Vertebroplasty [ver-TEE-broh-plas-tee]. Putting a special cement into a collapsed vertebra to support the damaged bone and help with pain. 
• Kyphoplasty [KY-foh-plas-tee]. Injecting a special balloon and cement into a collapsed vertebra, similar to vertebroplasty. The balloon is inflated inside the vertebra to restore the original height of the bone, and the cement helps preserve this shape after the balloon is removed. 
• Total disc replacement or arthroplasty [AHR-thruh-plas-tee]. Removing an entire damaged spinal disc and replacing it with an artificial disc to help preserve motion between 2 vertebrae. 

Although not all cases of degenerative disc disorder can be prevented, there are some things that can be done to help prevent the condition. Some of these include:

• Avoiding trauma to the spine
• Maintaining a healthy body weight
• Avoiding or quitting smoking
• Keeping good posture 
• Regularly exercising to keep the muscles in the back strong