The Aging Spine:
Osteoarthritis and Other Degenerative Conditions of the Spine
Herniated Lumbar Disc

Ruptured, slipped, or herniated discs are usually synonymous. Herniated discs most commonly occur in 20 to 50 year old patients, but can occur at all ages. In older patients, they may again be associated with arthritis and nerve root compression.

Symptoms and Diagnosis

Typically, most people will have an episode or two of low back pain not necessarily associated with a traumatic event and will subsequently develop leg pain, commonly known as sciatica. Discs rupture and herniate because of degeneration and tears in various parts of the disc. In patients whose symptoms last longer than several weeks, or who have significant and/or progressive leg weakness or loss of bowel and bladder function, an MRI scan or a CT scan should be performed to identify the abnormality.

Treatment

Symptoms are frequently self-limited and respond to restriction of activity, non-steroidal anti-inflammatory medications, and short periods of bed rest. Most people recover without surgical treatment. If the pain is particularly severe, then exercise and physical therapy are considered. If the symptoms decrease, gradual return of full activities may take about four weeks. Although steroid medications that have been used to treat the sciatica in the past are still valuable drugs for this purpose, they are often associated with significant complications and should be used only briefly, if at all.

If there is no improvement within one to three months with nonoperative measures or if leg pain or weakness persists or worsens, surgical treatment may be suggested. The most common procedure for this condition is a discectomy in which a small incision is made in the back and the herniated portion of the disc is removed. Relief of symptoms is often quite dramatic. Healthy patients undergoing this surgery can have it done as an outpatient procedure, but occasionally the side effects of anesthesia and pain medication used postoperatively require admission to the hospital for a day or two. After the surgery, some recovery is necessary, but gradual return to activities is the rule. The time it takes to return to work and sports activities varies and should be discussed with the patient's surgeon.