Herniated and Bulging Disc\Lumbar Spine

A side view of the lumbar spine shows normal discs, spinal canal, and nerve roots (see figure 1). Nerve roots normally float in the fluid-filled canal. Figure 2 shows a small herniated disc pushing into the canal toward nerve roots. Image courtesy of Intermountain Medical Imaging, Boise, Idaho. All rights reserved.



Axial MR image and Sagittal T-1 weighted MR image of the lumbar spine demonstrates disc herniation at L5-S1(asterisk).


A spinal disc herniation is a condition affecting the spine which a tear in the outer fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft portion (nucleus pulposus)to bulge out. Tears in the annulus fibrousus usually arise from a previously existing disc protrusion, which is a condition where the outermost layers of the annulus fibrousus are still intact, but can bulge when the disc is under pressure.

Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar and cervical disc herniation. The lumbar is the most common site for disc herniation and is the main cause for lower back pain. Lumbar disc herniations occur in the lower back, most often between L4 and L5 or between L5 and S1 vertebral bodies. Disc herniation can occur from general wear and tear, such as jobs that require constant sitting, or heavy lifting. Smoking is a major risk factor as the chemicals within smoke cause diminished nutrition and oxygenation of the discs leading to dehydration and degeneration which can progress to herniation. There is also a strong genetic component that has been known to contribute to lumbar disc herniation.

Symptoms of a herniated disc can vary depending on the location of the herniation and the type of soft tissue involved. They can range from little or no pain if the disc is the only tissue injured. However if the nerve roots are irritated or impinged by the herniated material the pain can be very severe. Unlike pulsating pain the pain that comes from a herniated disc is usually continuous and in a specific position of the body sometimes radiating down into other parts of the body. This kind of pain is known as electic shock pains. Other symptoms include tingling and numbness, muscle weakness, and could include bowel or bladder problems which require medical attention right away.

Most often your physician can a make the diagnosis of a herniated disc by a physical examination. The examination includes testing sensation, muscle strength, and reflexes and also utilizing different forms of imaging like X-ray, CT, and MRI. An MRI is the most commonly used exam in making the diagnosis of a herniated disc in conjunction with the physical examination findings.

Most often treatments of a herniated disc begin conservatively and become more aggressive if the symptoms persist. Treatment usually begins with rest and activity modification, along with ice and heat applications. Then physical therapy and anti-inflammatory medications, topical as well as oral. More aggressive treatments are also used such as epidural steroid injections and lastly surgery.