Conditions & Treatments

Lumbar Disc Herniations and Sciatica:
An Introduction for Patients and Health Care Professionals
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Approximately 80% of Americans have episodes of back pain at some time in their life that is bad enough that they see a health care professional. One of the more common causes of these episodes is a condition known as degenerative disc disease. As the disc ages, it can lose its normal fluid content and become degenerative and arthritic. Another condition that can occur in the disc is known as a disc herniation. In this condition, the outer portion of the disc can tear, and the inner portion (known as the nucleus pulposis) can then herniate through the tear in the disc and enter into the neural canal. When this occurs, the person can experience severe pain that runs from the buttock down the affected leg (so called “sciatica”). Figure 1 is an MRI of a patient showing a large disc herniation “ruptured” into the spinal canal (red arrow). The patient was having severe back and leg pain.

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Treatment of the lumbar disc herniation is based upon the severity of the patient’s symptoms and the results of a physical examination. The majority of disc herniations can heal over weeks to months with little or no treatment. So, if a patient has fairly mild symptoms and can stay active, one option is just to allow sufficient rest and time for the herniation to heal. Medications can be used to ease the discomfort from a herniation to see if the patient’s symptoms improve over time. If more aggressive treatment is required, the next level of care can often involve some type of “hands on” but non-invasive treatment such as physical therapy or chiropractic care. If the pain is particularly severe, a procedure known as an epidural steroid injection can be performed in which an injection of steroid and anesthetic is given into the neural canal onto the inflamed nerve. An epidural steroid injection can often relieve pain and inflammation along a nerve within 2-3 days.
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There are three main indications for surgery in the lumbar disc herniation. First, if the patient’s pain is sufficiently bad and has failed non-operative care, the patient may request surgery to relieve the pain. Secondly, if the patient can not afford to be “layed up” for weeks to months for the herniation to heal, such as in someone who is self employed, the patient may request surgery to get back to their pre-injury activity level as soon as possible. Finally, if we see a patient with a large disc herniation and it is causing “nerve damage” such as in the case when a patient is dragging their foot secondary to weakness, surgery is recommended to remove pressure off the nerve and improve the chances of a full recovery.
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The surgical option for a lumbar disc herniation should not be taken lightly, but in general it is a safe procedure with a less than 1-2% complication rate and, in the appropriately selected patient, a greater than 90% chance of a good or excellent result. There are also newer and less invasive options available allowing surgery to be performed either “percutaneously” through a needle puncture with an endoscopic LASER system or through small incisions and often as an outpatient (Figure 2). If you have been told you have a disc herniation, a thorough discussion with your doctor should be had and a treatment plan started which best fits your needs.

Treatments for Lumbar Disc Herniations and Sciatica

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