What is Lumbar Disc Herniation?

A herniation is a protrusion of the disc or a partial or total leakage of the cushiony gel that is contained in the disc. This causes nearby nerves to protrude, touch the spinal canal, and cause pain. Discs are located along your spinal column, in between the vertebrae (bones) in your back. The discs in your lower back are often the most affected.

This condition is experienced mostly in patients between 30 and 50 years of age.

A herniation can appear anywhere on the disc, even below the disc which makes it difficult to see sometimes on scans.

What are the Types of Herniated Discs?

There are three types of herniated discs: contained, uncontained, and migrated.

  • Contained – This is the most common and occurs when the cushiony gel inside the vertebra leaks within the vertebra but does not leak outside of it.
  • Uncontained – This occurs when the cushiony gel leaks outside of the disc but doesn’t leak into the spinal canal.
  • Migrated – This occurs when the leaked cushiony gel completely leaves the disc and migrates into the spinal column.

What are the Symptoms of a Herniated Disc?

  • Lower limb pain
  • Pain that runs from your spine to your leg
  • Low back pain
  • Poor posture
  • Pain, numbness or tingling in the leg, possibly the top and bottom of the foot and the big toe
  • Difficulty bending your leg or knee
  • Decreased ability to flex your foot or big toe
  • Decreased ability to stand on your toes

If you have symptoms of a herniated lumbar disc, book an appointment online with Prof. Pier Paolo Maria Menchetti at UPMC Salvator Mundi International Hospital for a diagnosis and treatment options.

How is a Herniated Disc Diagnosed?

In some cases, a CT scan may be sufficient, but your doctor may order an MRI of the lumbar spine. They may also order an EMG to assess muscle strength and rule out other diagnoses.

How Do You Treat a Herniated Disc?

There are surgical and non-surgical options to treat lumbar disc herniation.

Non-Surgical Options

If your symptoms are relatively new, your doctor may order bed rest, anti-inflammatory drugs, corticosterioids, non-corticosteroids, and physical therapy. In more serious, longer lasting cases, your doctor might consider an injection of cortisone into the spinal canal to reduce swelling or spinal manipulation.

In most cases, symptoms resolve in 4 to 6 weeks.

Surgical Options

For patients with lingering pain after two months, no response to anti-inflammatory medication, and those where movement is significantly compromised, surgery may be considered. Surgery can be performed percutaneously using minimally invasive techniques or using more traditional, open techniques.

Percutaneous Surgery (Minimally Invasive)

Percutaneous treatments can involve no incision or just a small incision. They are performed using radiology or CT to guide the surgeon to the spine. These include:

  • Nucleoaspiration – This method uses a tool that removes the cushiony part of the disc which reduces the pressure within the disc allowing the nerve to decompress, reducing or eliminating the pain. This procedure is done under local anesthesia and uses a small incision. The success rate is 65-70%.
    Pain in the lower limb may persist for a few weeks, even in the case of a successful result. It works best on small and medium-sized hernias.
  • Nucleoplasty (Coblation) – This technique uses radiofrequency that generates heat to dissolve damaged tissue and decrease pressure in the disc. It is performed under local anesthesia with mild intravenous sedation, using radiology guidance. The success rate is 65-70% and is recommended for small and medium sized hernias.
  • LASER Discectomy – This acronym stands for Light Amplification (by) Stimulated Emission (of) Radiation. This option uses a laser that vaporizes and diminishes the damaged tissue, with no impact to surrounding tissues. When the damaged tissue is removed, the nerve decompresses and pain typically decreases. The procedure is performed under local anesthesia using X-ray or CT guidance. This technique is used for contained hernias and hernias in which there is a small degree of leakage. Success rate is 80%.
  • Endoscopic Surgery – In this newer technique, spine surgeons use endoscopes to view the disc, impacted nerves, and removed the damaged tissues or cushion. This method is not yet widely used and has a success rate close to 70%.

Open Surgery

Open surgery requires an incision and is used when minimally invasive procedures are not an option or when a patient seeks a success rate higher than 70%. These include:

  • Conventional Discectomy – Here the surgeon makes a 6-8 cm incision and removes a portion of the vertebrae and ligaments to expose the nerves of the spine and the herniated disc. The ruptured disc is then removed, which decompresses the nerve and alleviates pain. This approach is used in contained hernias. In uncontained hernias the leakage is removed, and the disc is emptied. In migratory hernias, the disc is identified and emptied, and the leaked tissue is removed from the spinal canal. The patient can move about after two days and is usually discharged after 3-5 days.
  • Conventional Microdiscectomy – This is performed using a smaller incision and less involvement of the back muscles. With this procedure, less of the vertebral bone is removed while still removing the damaged part of the disc, freeing up the nerve and reducing the pain. This is a good option for migrated hernias. Normally, the patient is discharged the day after surgery with physical therapy after 10 days, and sedentary work resumed after 2-3 weeks. In terms of the disappearance of limb pain, the satisfaction rate is approximately 90-95%.
  • In the short and medium term this is better than conventional discectomy but after 6-8 months, the result is similar. However, either with conventional methods or with microdiscectomy, a mild low back pain may persist overtime or eventually reappear as the treated disc degenerates or as additional discs degenerate.
  • Microdiscectomy with endoscope – This procedure uses an even smaller incision to guide an endoscope. The endoscope travels to the damaged disc and follows the same process as the conventional microdiscectomy. This is a more complicated procedure and because it has no significant advantages over microdiscectomy, it is not frequently used.

Spine Center at UPMC Salvator Mundi International Hospital

The Spine Center at UPMC Salvator Mundi International Hospital is an innovative and multispecialty center for the diagnosis and treatment of spine disorders and diseases. For a diagnosis and treatment options, book an appointment online today with Prof. Pier Paolo Maria Menchetti.