I would like to address what it means to have disk herniation in your lumbar spine. It seems that many patients may have been given this diagnosis but have never really had it fully explained to them if they have never been to our practice. Hopefully I can give you a better understanding of what this means and when to seek consultation with a spine specialist at the Chicago back Institute.
Our spine is made up of individual bones called vertebrae, which stack vertically, to make up our spinal column. Between each vertebra there is an inter-vertebral disc. These are present throughout the cervical spine with the exception of between the first and second cervical vertebrae. They are also present between each thoracic and lumbar vertebra. The purpose of the disc is to act as a cushion between the vertebrae, but also to allow motion between vertebrae while providing some stability. The outermost portion of the disc is a ligament like structure called the annulus. The central portion of the disc is called the nucleus pulposis. This is often viewed as a jellylike substance, however the consistency is much more like crabmeat.
The first thing to consider is that abnormalities of the disc can be fairly common even in people who have no symptoms whatsoever. Therefore your herniated disc may have nothing to do with your symptoms. While lumbar disc herniations can cause back pain, more frequently they will produce symptoms into the leg. Lumbar disc herniation typically causes symptoms by pressing upon or inflaming one or multiple lumbar nerve roots. These lumbar nerve roots exit the spine and travel to the legs. Therefore numbness, tingling, weakness or pain into the legs would be more typical if symptoms are related to the disk herniation. The simple fact of having a bulging disc or a herniated disc does not mean that this is the cause or certainly the only cause of someone's symptoms. Our job as neurosurgeons is to correlate what we see on a patient's films to their specific symptoms and physical examination.
The fact that you may have a lumbar disk herniation does not mean that surgery will always be required. As a matter of fact most patients can improve without surgical intervention. Approximately 90% of patients can improve or eliminate their symptoms without the need for surgical intervention if this is their first time with this problem, however sometimes this may take weeks or months. Our sophisticated knowledge, and experience with all types of spine disorders allows us to direct our patients to the appropriate conservative care that will produce the most expeditious and cost-effective resolution to the problem. Initial non-surgical care may involve over-the-counter non-steroidal anti-inflammatory medicines, prescription non-steroidal anti-inflammatory medicines, oral steroids, physical therapy or possibly epidural steroid injections. In some cases we may feel surgical intervention is likely to be the only resolution to the problem based on our experience and occasionally will recommend this is the initial treatment. This saves valuable time and resources in those cases where we feel conservative treatments are not likely to be of value.
Many patients may be anxious or nervous about seeing a spine surgeon after they have been diagnosed with a lumbar disc herniation because they may fear surgery. However as discussed above the majority of these cases can be alleviated without surgical intervention, and we are in a position to help direct the most appropriate conservative care when indicated in cooperation with your primary care physician or chiropractic physician.
Dr. Jerrel Boyer
