What Is Lumbar Disc Herniation?
Lumbar disc herniation occurs when the structure of the intervertebral disc deteriorates, causing the gel-like nucleus pulposus to shift backward or sideways into the spinal canal and compress the nerve roots. This condition presents with a wide spectrum of symptoms ranging from severe low back and leg pain to muscle weakness.
Causes and Risk Factors
Lumbar disc herniation most commonly develops as the disc weakens over time. The primary causes and risk factors include:
Degenerative Changes:
With age, the disc loses water content and elasticity, gradually weakening. This natural process is the most frequent underlying mechanism for herniation.
Trauma and Mechanical Load:
Sudden heavy lifting
Falls or direct impact
Sudden axial loading on the spine
Overuse and Repetitive Movements:
Working in a continuously forward-bent position
Physically demanding occupations
Genetic Predisposition:
Individuals with a family history of lumbar disc herniation have a significantly higher risk.
Lifestyle Factors:
Smoking
Sedentary lifestyle and weak core musculature
Poor sitting, sleeping, and working posture
Prolonged desk-based work
Symptoms
The severity and distribution of symptoms depend on the location of the herniation and the degree of nerve root compression.
Most Common Symptoms:
Leg pain (sciatica): Burning or electric shock–like pain radiating from the lower back to the buttock and down the leg
Low back pain
Numbness and tingling
Muscle weakness
Diminished reflexes
Difficulty standing or walking
Lumbar disc herniation diagnosis and management
Neurological Examination: Assessment of muscle strength, reflexes, sensory function, and the specific nerve root involved.
Lasègue Sign Test: A clinical test used to assess lumbosacral nerve root irritation. Reproduction of radicular pain when the straightened leg is raised between 30–70 degrees suggests nerve root compression, commonly due to lumbar disc herniation.
Magnetic Resonance Imaging (MRI): Lumbar disc herniation radiology: The gold standard for diagnosing lumbar disc herniation. It shows the degree of disc rupture, the extent of nerve compression, and associated pathologies.
Computed Tomography (CT): Preferred in patients who cannot undergo MRI.
X-ray (Lateral, Hyperflexion and Hyperextension Views): Does not show discs, but provides information on spinal alignment, curvature, and potential instability.
Electromyography (EMG): Evaluates nerve damage, conduction velocity, and the degree of muscle involvement.
Treatment Approaches
Not Every Patient Requires Surgery!
About 80–90% of lumbar disc herniations improve with non-surgical treatment. Surgery is considered only when nerve compression progresses, muscle weakness develops, or pain persists despite adequate treatment.
1. Conservative (Non-Surgical) Treatment
a. Short-Term Rest and Activity Modification
5 days of rest during the acute phase help reduce inflammation and muscle spasm. Extended bed rest of 16–17 hours per day may help relieve severe acute pain but should be temporary.
b. Corset Use
Lumbosacral silicone-supported corsets may provide relief during the acute pain phase.
Usage principles:
Daily use approximately 14 days, removed during sleep.
Steel-reinforced corsets are not recommended due to the risk of muscle weakening.
Lumbosacral silicone-supported corsets are generally preferred.
After 14 days, use when necessary (e.g., travel, lifting, bending).
c. Medication
NSAIDs: Reduce inflammation and pain.
Muscle relaxants: Relieve acute muscle spasm.
d. Physical Therapy
Exercises that strengthen the back and abdominal muscles.
Spasm-relieving modalities.
Manipulative, forceful maneuvers are not recommended; controlled strengthening programs are preferred.
f. Lifestyle Modifications
Correct sitting and standing posture
Proper mattress use (medium-firm) and appropriate orthopedic or bi-convex pillows.
When getting into or out of bed, turning to the side first and supporting the body with the arm.
Weight loss.
Regular exercise.
Smoking cessation.
2. Surgical Treatment (If Necessary)
Surgery is considered in the following situations:
Persistent severe pain despite 6–8 weeks of treatment.
Recurrent pain occurring 3-4 times per year.
Advanced nerve compression findings.
Development of muscle weakness.
Surgical Procedures
Microsurgical Discectomy:
A minimal invasive procedure performed through an approximately 1,5-2 cm incision. The herniated disc fragment compressing the nerve root is removed under a microscope.