Slipped disc / herniated disc in lumbar spine

Due to a weakness of the posterior part of the disc, damages of the cartilage ring (anulus fibrosus) can occur. That is, the posterior protective ring tears or protrudes. Through the tear, the softly inner part of the disc protrudes and, thereby, compresses and irritates a nerve (see images A and B). Physicians then talk about slipped disc, disc herniation or disc prolapse.

Symptoms slipped disc / herniated disc lumbar spine
A slipped disc can cause pain in the back but also radiating pain into buttocks, legs and feet. At the worst, a slipped disc results in paralysis and sensation loss. Even during protrusion, the nerve is irritated, so that severe pain can arise. The symptoms of a slipped disc in lumbar spine in short:

• back pain
• pain radiating from bottocks into legs and feet
• paralysis and sensation loss

Which kind of complaints occur depends on height and direction of slipped disc. It is differed between those that are in the middle and cause back pain, and those that are more lateral and cause leg pain.

 

Causes slipped disc / herniated disc lumbar spine
Not only heavy lifting and accidents but wrong body twisting and certain movements can cause a slipped disc if there is a genetic disposition. Risk factors comprise hereditary factors (’weakness of the connective tissue’), overweight and a lack of movement, permanent sitting, some occupational strains (trucker) and smoking. Furthermore, a bad muscle condition can enlarge the risk of a slipped disc.
Anatomical and biomechanical factors play a certain role in the prevalence of a slipped disc, especially in the lower third of the cervical and lumbar spine. Mainly the spinal segments L 4/5 and L5/S1 are affected. The causes of slipped disc in lumbar spine in an overview:

• heavy lifting, accidents and certain movements
• hereditary factors ('weakness of the connective tissue')
• overweight
• lack of movement
• certain occupational strains
• bad muscle condition

Diagnostics slipped disc / herniated disc lumbar spine

To differentiate a slipped disc from other spinal diseases causing similar complaints, patients first get a neurological-orthopedic examination including a comprehensive talk about the history and treatment of illness. Often imaging examinations like MRI follow. Magnet resonance imaging enables us to examine and visualize a slipped disc and other spinal diseases very thoroughly. At Beta Klinik we use an open MRI system which allows us to comfortly examine patients suffering from claustrophobia or patients up to 250 kg (500 lbs).

The upper MR image shows a large herniated disc in the lowest lumbar segment with compression of the nerve roots. At the lower MR image, the same herniated disc is depicted transversally.

Therapy slipped disc / herniated disc lumbar spine
Some slipped discs can be successfully treated by conservative means: use of painkilling and anti-inflammatory drugs and avoidance of heavy strains, especially bending over, lifting, pulling and quick turns. In such cases, the healing process of a slipped disc takes significantly longer. After acute pain treatment, a physiotherapy programme with specific exercises for the strengthening of the abdominal and back muscles should follow. A revision of slipped disc therapy and surgery has to be discussed if conservative therapy does not improve the condition substantially; that means if pain is unbearable or neurological deficits occur. It is outdated that surgery in case of slipped disc is only indicated if neurological deficits exist or paraplegia seems to be imminent. In the face of minimally invasive surgery techniques, it is no longer recommendable to comply with the so-called stepwise phase model, which dictates 6 weeks of conservative measures.
Apart from classical indications (acute paralysis, imminent paraplegia), surgical removal of a slipped disc is even indicated after a few days due to heavy pain, decrease of sensation, imaging-proven symptomatic slipped discs, and with regard to the individual occupational and private life situation. Please click here to get comprehensive information about when surgery is medically indicated.
Therapy options of slipped disc encompass

• Conservative treatment
• Microtherapy
• Endoscopic surgery
• Microsurgery
• Disc prosthesis surgery / ADR - Artificial disc replacement

The therapy of a slipped disc with microtherapy is comparable with microtherapy of vertebral joints. Under CT navigation, a thin needle is inserted into the osseous nerve root canal. Through this needle we inject swelling reducing and painkilling drugs around the nerve root. Like microtherapy of vertebral joints, microtherapy of a slipped disc has to be repeated two or three times in weekly intervals. The drugs can be applied epidurally in severe cases. This means that they are injected into the spinal canal right before the dural sack.
Endoscopic surgery in case of a slipped disc is a very gentle and efficient method that has revolutionized slipped disc therapy. This kind of surgery is easy on muscles and tendons. Instead of making a skin cut, the endoscope is inserted through natural openings of the spine. Such a procedure is possible because the endoscope has an diameter of only 7 mm (0.28 inches). Through this small opening, we work with small instruments to remove the disc herniation. You can find detailed information concerning endoscopic surgery in case of slipped disc by clicking here. In some cases, it can be useful to perform an endoscopic abrasion. This minimally invasive endoscopic method does not only allow the gentle removal of slipped discs/disc protrusions, but also induces a regeneration of these discs. To improve regeneration and revitalization, the calcified ground and end plate of the adjoining vertebral bodies are perforated by minute instruments inducing the migration of stem cells into the disc space. It also enhances the water balance of the disc. Here you find more information on endocopic abrasion.
The safety and effectiveness of the microurgical removal of a disc herniation is similar to those of endoscopic surgery. But instead of using and endoscope, a special operation microscope is employed and a small skin cut is necessary. By means of the microscope, our phyiscians are able to operate very precisely. Here you can read more about microsurgery. In some cases, a disc is replaced by an artificial disc during disc prosthesis surgery / artificial disc replacement (ADR) surgery. The artificial disc preserves the spinal flexibility despite the removal of the natural disc. Click here to learn more about disc prosthesis / artificial disc replacement (ADR) surgery.


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