A prolapsed lumbar intervertebral disc, commonly referred to as a herniated disc, is a condition where the soft inner gel-like material of a lumbar disc (nucleus pulposus) protrudes through a tear or weak spot in its outer fibrous layer (annulus fibrosus). This can compress nearby nerves in the spinal column, leading to localized or radiating pain, weakness, or numbness.
Anatomy of the Lumbar Spine
The lumbar spine consists of five vertebrae (L1–L5) with intervertebral discs in between. These discs act as shock absorbers, allowing flexibility and protecting the spine during movement. The most common levels affected are:
- L4-L5
- L5-S1
Causes of PLID
- Age-related degeneration (most common):
- Discs lose water content and elasticity over time, becoming prone to injury.
- Trauma or injury:
- Sudden impact or lifting heavy objects improperly.
- Repetitive strain:
- Prolonged sitting, bending, or twisting.
- Obesity:
- Increased pressure on lumbar discs.
- Genetics:
- Predisposition to weaker disc structures.
Symptoms of PLID
- Local Symptoms:
- Low back pain, often sharp or aching.
- Radicular Pain (Sciatica):
- Radiating pain down the leg, typically following the affected nerve’s path (e.g., sciatic nerve).
- Neurological Symptoms:
- Numbness or tingling in the legs or feet.
- Muscle weakness, particularly in the lower limbs.
- Difficulty in Movement:
- Restricted range of motion and stiffness.
- Bladder or Bowel Dysfunction (Rare but serious):
- Indicates cauda equina syndrome, a surgical emergency.
Diagnosis
- Clinical Examination:
- History of symptoms and physical tests.
- Straight Leg Raise Test (SLR): Pain when the leg is raised straight while lying down.
- Motor function test, Sensory function test and Reflexes.
- Imaging Studies:
- MRI: Best for visualizing disc herniation and nerve compression.
- CT Scan: Useful if MRI is contraindicated.
- X-ray: To rule out fractures or other structural abnormalities.
- Nerve Function Tests:
- Electromyography (EMG) or Nerve Conduction Studies.
Treatment
Non-Surgical Management (Conservative Treatment) – 90%
- Rest:
- Short periods of rest to reduce strain, but prolonged bed rest is discouraged.
- Medications:
- Pain relievers: NSAIDs like ibuprofen or acetaminophen.
- Muscle relaxants: To alleviate spasms.
- Neuropathic pain agents: Gabapentin or pregabalin.
- Steroids: Oral or epidural injections for inflammation.
- Physical Therapy:
- Exercises to strengthen back and core muscles.
- Techniques for improving posture and flexibility.
- Lifestyle Modifications:
- Avoid heavy lifting, prolonged sitting, and improper posture.
- Weight management to reduce lumbar spine stress.
- Epidural Steroid Injections:
- For persistent pain not relieved by medications.
Surgical Management (Indicated in Severe Cases)
Surgery may be necessary if:
- There is significant nerve compression causing weakness or paralysis.
- Symptoms persist despite conservative treatment for 6–12 weeks.
- Cauda equina syndrome is present.
Common surgical procedures include:
- Microdiscectomy:
- Removal of the herniated portion of the disc to relieve nerve pressure.
- Endoscopic Discectomy
- Removal of the herniated portion of the disc to relieve nerve pressure through endoscope.
- Laminectomy:
- Removal of part of the vertebra to decompress the nerve.
- Spinal Fusion:
- Stabilizing the spine in cases of instability.
- Artificial Disc Replacement:
- Replacing the damaged disc with an artificial one.
Prevention of PLID
- Proper Lifting Techniques:
- Bend your knees and keep your back straight when lifting heavy objects.
- Regular Exercise:
- Focus on strengthening core and back muscles.
- Maintain Good Posture:
- Avoid slouching while sitting or standing.
- Healthy Weight:
- Reduces stress on the lumbar spine.
- Avoid Repetitive Strain:
- Take frequent breaks during prolonged sitting or repetitive activities.
Prognosis
Most cases of PLID resolve with conservative treatment. Surgery, when necessary, typically has a high success rate. Early diagnosis and treatment are key to avoiding long-term complications.