What is a herniated lumbar disc and why does it occur?
The intervertebral discs are fundamentally made up of two structures: a soft center called the nucleus pulposus and a peripheral barrier called the annulus fibrosus.
In lumbar herniated discs, the annulus fibrosus has been weakened and this leads to the nucleus pulposus coming out, generally towards the site of the nerves that go to the lower extremities. It is the contact between the disc material against the nerves that gives rise to the symptoms.
How does it manifest itself or what are its symptoms?
The manifestations of herniated discs are varied: pain down the thigh or legs (also known as sciatica), low back pain, altered sensation or decreased strength in the lower limbs and in more advanced cases may even present with altered sphincters.
Is it easy to diagnose this health problem?
In order to diagnose this health problem, a clinical assessment by a qualified professional is necessary, whose findings must correspond with those derived from complementary tests that allow not only to identify the existence of a hernia but also to rule out other medical conditions that present similar clinical manifestations.
Are there people more likely to suffer from this problem? Are there factors that favor its appearance?
It is more frequent in men than in women, between 30 and 50 years of age, although it is becoming more frequent in younger people.
Factors such as smoking, being overweight, carrying heavy objects or making repetitive bending and twisting movements of the trunk favor the appearance of lumbar herniated discs.
Is it a preventable health problem?
It is essential to maintain a healthy posture when performing daily physical activities, at work or during recreational activities.
Avoiding smoking, maintaining a good control of body weight and performing physical activities that strengthen the lumbo-abdominal or ‘core’ muscle girdle help additionally in prevention.
What are the possible complications that we may encounter?
When there is no improvement after a herniated disc, symptoms can worsen and even become chronic, leading to a long-term worsening of quality of life.
What are the most effective treatments we have to address this problem?
In the case of a lumbar disc herniation, unless there is a significant affectation in strength or alteration in sphincter control, within the first six weeks a treatment based on analgesics, anti-inflammatory drugs and different modalities of physical therapy should be tried, depending on the pain.
For those cases with pain refractory to this first therapeutic approach we recommend epidural infiltrations, and for the rest of cases it is necessary to evaluate the different surgical options: open surgery, microdiscectomy, percutaneous endoscopic discectomy, disc prosthesis or intervertebral fusions.
They all aim to remove the disc material in contact with the affected nerve, and are distinguished by the approach, the residual function of the intervened disc, recovery time and discharge care; therefore, it is necessary to adjust the treatment to the needs of each individual.