Herniated or Ruptured
Lumbar Disc

Herniated discs most commonly arise in patients ages 20 to 50 years, but can occur at all ages. In older patients, they may again be associated with arthritis and nerve root compression.

Symptoms

Typically, most people will have an occasional episode of low back pain not necessarily associated with a traumatic event and will subsequently develop nerve-related leg pain, commonly known as sciatica. If these symptoms don’t resolve in several weeks, a physician should be consulted to see if the pain is a result of a disc rupture or herniation. Discs rupture and herniate because of degeneration and tears in various parts of the disc. In addition to low back pain and sciatica, patients with a severely ruptured or herniated disc may experience loss of bladder or bowel function and progressive leg weakness.

Imaging Evaluation & Diagnostics

If a patient has symptoms of a herniated or ruptured disk, a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan should be performed to identify the abnormality.

Treatment Options

Non-Operative Treatment

Self-limited symptoms usually respond well to the following:

• Restriction of activity
• Non-steroidal anti-inflammatory medications
• Short periods of bed rest
• Oral steroid medications, still viable and used to treat the sciatica, are often associated with significant complications and should be used for brief periods, typically 5-7 days.
• Epidural in the spinal canal (near specific nerve roots)
• Exercise and physical therapy if pain is particularly severe. If the symptoms decrease, gradual return of full activities may take about 2 - 6 weeks.

Operative Treatment

If 6 weeks to 3 months with non operative measures does not produce symptom improvement, 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 can have this surgery in an outpatient setting, but occasionally the side effects of anesthesia and pain medication used postoperatively require admission to the hospital for a 1 to 2 days. After the surgery, some recovery is necessary, but gradual return to full 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.

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