The vertebral column, also called the backbone, is made up of 33 vertebrae that are separated by spongy disks and classified into four distinct areas. The cervical area consists of seven bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of five bony segments in the lower back area; five sacral bones (fused into one bone, the sacrum); and four coccygeal bones (fused into one bone, the coccyx).
Lumbar disc disease occurs in the lumbar area of the spine. The lumbar area of the spine (and other areas of the spine) is made up of two parts, including the following:
vertebral bodies - the parts that are made of bone.
The vertebral bodies are numbered from 1 to 5 in the lumbar spine and the discs are located between two of the vertebral bodies and are numbered accordingly (such as a disc at L2-3, or between the lumbar discs numbered 2 and 3).
The intervertebral disc is composed of two parts, including the following:
annulus fibrosis - a tough outer ring of fibrous tissue.
As we age, the intervertebral disc may lose water and become dried out. As this happens, the disc compresses. This may lead to the deterioration of the tough outer ring allowing the nucleus, or the inside of the ring, to bulge out. This is considered a bulging disc.
As the disc continues to degenerate, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is considered a ruptured, or herniated, disc. The fragments of disc material can then press on the nerve roots that are located just behind the disc space. This can cause pain, weakness, numbness, or changes in sensation.
Most disc herniations happen at the lower lumbar spine, especially at the L4-5 and L5-S1 levels.
Lumbar disc disease is due to a change in the structure of the normal disc. Most of the time, disc disease comes as a result of aging and the degeneration that occurs within the disc. Occasionally, severe trauma can cause a normal disc to herniate. Trauma may also cause an already herniated disc to worsen.
The symptoms of lumbar disc disease vary depending on where the disc has herniated, and what nerve root it is pushing on. The following are the most common symptoms of lumbar disc disease. However, each individual may experience different symptoms. Symptoms may include:
The symptoms of lumbar disc disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for lumbar disc disease may include the following:
Specific treatment for lumbar disc disease will be determined by your physician based on:
your age, overall health, and medical history
Typically, conservative therapy is the first line of treatment to manage lumbar disc disease. This may include a combination of the following:
When these conservative measures fail, surgery for removal of a herniated disc may be recommended. Surgery is done under general anesthesia. An incision is placed in the lower back over the area where the disc is herniated. Some bone from the back of the spine may be removed to gain access to the area where the disc is located. Typically, the herniated part of the disc and any extra loose pieces of disc are removed from the disc space.
After surgery, restrictions may be placed on the patient's activities for several weeks while healing is taking place to prevent another disc herniation from occurring. Your physician will discuss any restrictions with you.