Lumbar Disc Herniation
Washington University spinal neurosurgeons have extensive experience in the treatment of lumbar disc herniations.
Our surgeons provide a full range of treatment options, ranging from conservative approaches to advanced surgical treatment.
Conditions & Treatments
The spine is made up of several segments:
- Cervical spine (7 bones in the neck),
- Thoracic spine (12 bones in the mid-back, each with a rib attached)
- Lumbar spine (5 bones in the low back)
- Sacrum (tailbone)
The bones in the top three segments (cervical, thoracic, and lumbar) are all separated by discs, which act as cushions or shock absorbers between the bones. The discs, composed of a thick outer band (fibrous annulus) and softer inner cushion (nucleus pulposus), help absorb energy in the spine and also help in movement. The sacrum is normally fused together, without remaining discs.
With time, these discs can wear, or degenerate, especially in the low back. This happens naturally in the process of aging, but can also happen prematurely as a result of various factors, such as trauma (car accidents, falls), repetitive injury from certain occupations or sports, or even genetic factors. When discs degenerate, they can rupture, or herniate against the nerves in the spine. This can cause radiculopathy – nerve compression resulting in pain shooting down the buttock and into the leg, numbness in the leg or foot, or even weakness of part of the leg.
Most lumbar disc herniations, while initially associated with quite severe pain, will heal spontaneously with time and conservative treatments. Bedrest, anti-inflammatory medications and physical therapy are often tried before referral to a spine surgeon. Epidural injections for pain control are often quite helpful as well. However, a small number of disc herniations will not heal with conservative treatments, and surgery may be indicated. Surgery is typically recommended when symptoms do not respond to conservative options, when a patient has a progressive weakness, or when the pain is so severe that it interferes with conservative options.
Rarely, a large disc herniation can cause cauda equina syndrome, a disorder that affects the bundle of nerve roots (caudal equina) at the lower end of the spinal cord. This can result in loss of bowel or bladder control and marked weakness. This is a surgical emergency and patients with these symptoms should proceed directly to their local emergency room for evaluation.
Surgery, if recommended for lumbar disc herniation, is often a limited operation, with same-day or overnight stay surgeries commonly performed by Washington University spinal surgeons.
More than 2,100 spinal consults per year