Lumbar Disc Disease - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

The vertebral column, also called the spinal cord or the backbone, consists of 33 individual bones. It includes seven cervical, twelve thoracic, five lumbar, and five sacral vertebrae. Only 24 vertebrae are movable, and the sacrum and coccyx vertebrae are fused. Intervertebral discs are fibrous ligaments that lie between the vertebrae and act as shock absorbers, providing a cushion-like effect to the vertebrae. These discs facilitate the movements of bending forwards, backward, and side to side. Intervertebral discs are made up of three components - nucleus pulposus, annulus fibrosis, and cartilaginous end plates:

• Nucleus Pulposus: The inner portion of the disc is a gel-like material responsible for the cushioning effect.

• Annulus Fibrosis: It is the outer portion of the disc, which is made of collagen and helps during the bending movements of the spinal cord.

• Cartilaginous End Plates: These connect the discs to the vertebrae and control the supply of nutrients to the intervertebral discs.

What Is Meant by Degenerative Disc Disease?

Degenerative disc disease condition occurs when the cushioning present in the spine starts to wear off. This is usually seen in elderly people. These cushions help to move, bend, and twist comfortably. When the cushion starts to wear off, they start to rub each other, causing pain.

What Is Lumbar Disc Disease?

Lumbar disc disease is caused by any change in the normal structure of the disc, which results in sharp pain and weakness in the back. It is also called herniated disc disease or slipped disc. The pain is generally due to the tearing of the disc, which is called herniation, or it can also be due to the bulging of the disc. Pain is usually low to moderate in intensity but is continuous. Occasionally, the pain flares up to severity, which can last several weeks and reduce mobility.

What Are the Causes of Lumbar Disc Disease?

• The age-related disease caused due to the drying of the gel-like material of the disc leads to reduced flexibility. Males are known to be more prone than females.

• Any injuries to the back region, like accidents, a fall, or a blow to the back, can result in lumbar disc disease.

• Jobs that require lifting heavy-weight objects and bending.

• Increased daily activities and aerobics and exercises, without proper guidance, can cause wear and tear.

• Improper postures or sitting for long periods.

• Driving continuously for long hours.

• Unhealthy lifestyle and overweight.

• Excessive smoking can reduce the oxygen supply to the intervertebral discs.

• Recent research also predicts genetic predisposition to the disease.

What Are the Symptoms of Lumbar Disc Disease?

• Numbness, pain, and weakness in the lower back region.

• Pain radiating to the lower extremities, associated with a tingling sensation.

• Pain can be severe when sitting or bending and reduced when lying down.

• Difficulty in walking and lifting the leg.

• Lack of balance or coordination.

How Is Lumbar Disc Disease Diagnosed?

Immediate medical advice should be consulted if there is any injury to the back, frequent back pain, or difficulty during bending or climbing steps, as the pain can radiate to the lower extremities and hamper daily activities. The doctor takes the complete medical history and conducts a physical examination initially, wherein the patient is asked to perform simple movements like bending, lifting the leg, turning the neck, sitting, and getting up. After the examination, the doctor may advise an X-ray. At later appointments, a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be recommended if there is no improvement in the condition. A myelogram or an electromyography may also be preferred.

What Are the Risks Associated With Lumbar Disc Disease?

• Patients with a family history of back pain and sports persons are susceptible to lumbar disc disease.

• Occupations that involve lifting weights, frequent bending, or changing positions.

• Lumbar disc disease can also lead to muscle spasms and pain radiating to the hips and legs.

• If left untreated, it can lead to lumbar stenosis or lumbar arthritis.

• If the disease is associated with bowel or bladder dysfunction, fever with backache, or excessive weight loss, immediate consultation with a physician is advised.

How Is Lumbar Disc Disease Treated?

Non-surgical or conservative methods to treat lumbar disc disease:

• Bed rest or sitting in a reclined position.

• Applying a cold or ice pack can help relieve pain and inflammation.

• Use of lumbosacral support.

• Heat therapy using heat pads or a warm bath can help reduce spasms and relax the muscles.

• Medications such as Ibuprofen, Acetaminophen, Tramadol, Naproxen, and Aspirin can help reduce pain and swelling. In some severe cases, epidural steroid injections are given.

• Physical therapies include massaging and muscle-strengthening exercises under a trainer's guidance, which will help support the spine and strengthen the neck and back muscles.

In the majority of the cases, improvement is seen with non-surgical methods. Still, surgical intervention may be necessary if there is no scope for improvement even after six weeks of therapy. Surgeries carried out are either lumbar discectomy or lumbar disc replacement surgery.

• Lumbar discectomy is the removal of the injured part of the disc or the complete removal of the disc. Analgesics are prescribed to relieve pain, and a back brace is advised for around two to three weeks, followed by physical therapy.

• Lumbar disc replacement surgery removes the degenerated disc and replaces it with an artificial disc (implant) made of metal or a combination of metal and plastic. This surgery is performed under general anesthesia and requires hospitalization for a few days.

• Surgery is followed by recovery and rehabilitation, which may take up to a few months.

Risks Involved After Surgery:

Some of the complications associated with lumbar disc surgery are:

• Implant failure.

• Dislodgement of the implant.

• Infection at the incision site can delay healing.

• Formation of blood clots due to decreased activity.

• Narrowing or stiffness of the spine.

How to Prevent Lumbar Disc Disease?

• Eating healthy food and maintaining weight as excess weight can put pressure on the spine.

• Regular physical exercises or practicing yoga under proper guidance.

• Following a proper posture or supporting the back when sitting for long periods.

• Taking precautions when bending or lifting heavy objects.

What Are the Complications of Lumbar Disk Disease?

Lumbar disk condition can result in back and leg pain which disturbs daily activity. It can result in leg weakness and numbness.

Conclusion

Lumbar disc disease is a common age-related ailment associated with severe back pain, especially during sitting or bending; it can be successfully managed when diagnosed early and treated conservatively or surgically with appropriate medications and a healthy lifestyle.