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Lumbar disc herniation is a condition that occurs when the cushion-like structures in the spine, known as discs, displace or tear, leading to the compression of nerves. This condition, medically referred to as disc herniation, arises due to the disruption of the spinal structure and is commonly observed in the lower back (lumbar region). Lumbar disc herniation exerts pressure on the spinal cord and nerve roots, causing pain that radiates to the lower back, hips, and legs.
Herniated disc occurs when the outer part of the discs between the vertebrae tears, allowing the gel-like substance inside to protrude outwards. Each disc in our spine is a crucial structure for enabling movement between the vertebrae and balancing the load on the spine. The discs absorb the pressure exerted on the spine and prevent the vertebrae from rubbing against each other. However, over time or as a result of sudden strain, the discs can become damaged and protrude into the spinal canal, putting pressure on the nerve roots.
Herniated discs most frequently occur in the lumbar spine region. The lumbar spine consists of five vertebrae numbered from L1 to L5 and bears the weight of the upper part of the body. Therefore, the lumbar region is the area most subjected to pressure on the spine, and the wear or damage of discs is more common in this region. When the outer layer of the discs between the vertebrae, known as the annulus fibrosus, tears, the inner gel-like structure, the nucleus pulposus, can leak out and compress nerves, leading to pain.
To understand why a herniated disc is significant, it's necessary to know its impact on the nervous system. Nerve roots that exit the spinal cord are responsible for movement and sensory functions throughout the body. Compression of these nerves by a herniated disc can cause pain, numbness, and weakness not just in the lower back, but also in the hips, legs, and even feet. Most patients describe the pain caused by a herniated disc as feeling like an electric shock or tingling sensation spreading down to their legs.
The spine is a structure consisting of 33 vertebrae, extending from the lower part of the head down to the coccyx. These vertebrae are interconnected bone structures that protect the spinal cord located within the spinal canal. The sections of the spine are classified as cervical (neck), thoracic (back), lumbar (lower back), sacral, and coccygeal. The spine also provides support to the body, enables mobility, and balances body weight.
The structure and functions of the discs, the discs between the vertebrae serve as the most important cushions of the spine. Each disc consists of an outer, tougher ring called the annulus fibrosus and an inner, soft, gel-like structure called the nucleus pulposus. This structure softens the movements between the vertebrae and balances the pressure on the spine. The discs also provide flexibility to the spine, enabling bending, twisting, and flexing movements.
How do discs function physiologically? During daily activities, the pressure applied to the spine is absorbed by these discs. During movements such as heavy lifting, bending, or twisting, the discs flex and maintain the spaces between the vertebrae. However, the structure of the discs can deteriorate due to aging or excessive strain. Over time, discs lose water, lose their elasticity, and become more prone to herniation.
Age-related disc degeneration is a commonly observed condition. As age progresses, discs begin to lose their water content, becoming thinner and more fragile. As the gel-like structure between the discs dries out, the internal pressure of the disc decreases, and its protective effect on the vertebrae diminishes. During this process, the pressure on the discs increases, and as a result, the risk of herniation rises. Over time, these structural deteriorations can lead to the tearing of the disc's outer layer, which in turn allows the leakage of the inner gel-like substance.
The anatomy and physiology of herniated discs demonstrate that within the complex structure of the spine, the discs play a vital role. Therefore, it is common for herniated discs to exert pressure on nerve roots over time, significantly affecting the patient's daily life.
Many factors play a role in the development of lumbar disc herniation. Aging, traumas, and genetic predisposition can trigger this condition. The discs play a critical role in balancing the load on the spine and enhancing mobility, but certain factors can lead to the weakening and herniation of the discs.
The most common cause of herniated discs is degenerative changes in the spine that occur with aging. As age progresses, the discs between the vertebrae lose their water content and elasticity. The gel-like structure inside the discs, known as the nucleus pulposus, dries out and becomes less flexible. The wear and tear of the discs lead to the outer tough layer, the annulus fibrosus, becoming more fragile. This situation makes the disc more vulnerable to pressure, causing the disc structure to weaken over time.
Degenerative disc disease is a condition frequently seen in elderly individuals and predisposes to herniation. Since the discs are responsible for balancing the load on the spine in daily life, the disruption of their structural integrity significantly increases the risk of herniation. The wear and tear of the disc's outer ring can lead to displacement of the disc even with small movements.
Sudden traumas are another significant cause of lumbar disc herniation. Straining movements such as lifting a heavy object, bending, or twisting suddenly can increase the pressure on the spine, leading to a tear in the disc. Particularly, a trauma occurring in the lumbar region can cause the disc between the vertebrae to shift and press on the nerve roots.
Accidents or falls, such as traumatic events, can cause sudden pressure and injuries to the spine. Herniation occurs as a result of the tearing or damage of the disc in the spine. Such strenuous conditions can lead to lumbar disc herniation even in young individuals. Incorrect posture or misuse of body mechanics during heavy lifting can also cause traumatic lumbar herniation.
Incorrect postures, unconsciously adopted in daily life, can increase the risk of herniated discs in the long term. Sitting at a desk for prolonged periods places additional strain on the back and lumbar region, disrupting the spine's natural curve. Particularly among desk workers, spinal deformations that can lead to herniated discs may develop if a proper sitting position is not adopted.
Using improper body mechanics during heavy lifting or bending movements increases the pressure on the discs. Especially bending from the waist without bending the knees can lead to excessive strain on the discs and herniation of a weakened disc. Therefore, the risk of lumbar disc herniation is higher in occupational groups that carry heavy loads (such as construction workers, warehouse staff).
Genetic predisposition also plays a significant role in the formation of lumbar disc herniation. In individuals with a family history of lumbar disc herniation, a weaker spine and disc structure or disc degeneration may be more common. Genetic factors can lead to the disc structure being thinner and more fragile, thus setting the stage for disc herniation.
Congenital anatomical differences can also increase the risk of herniated discs. For example, a narrow spinal canal or structural abnormalities in the spine can cause the discs to be exposed to more pressure than normal.
Lumbar disc herniation, also known as a herniated disc, occurs when the disc between the vertebrae herniates, exerting pressure on the nerve roots. This pressure affects the function of the nerves emanating from the spinal cord, leading to various symptoms such as pain, numbness, and loss of strength. The symptoms vary depending on the size of the herniation, which nerve roots are affected, and the severity of the condition. Below, the most common symptoms of lumbar disc herniation are examined in detail.
The most common symptom of a herniated disc is pain, which arises due to pressure on the nerve roots. The pain usually starts in the lumbar region but can spread to the hip, legs, and even the foot, depending on the severity of the nerve compression. This widespread type of pain, especially when the sciatic nerve is compressed, is known as sciatica. Sciatica is characterized by a sharp, burning, or stabbing sensation that starts in the lower back and extends through the hip, thigh, and down the back of the leg.
Pain felt in the lumbar region: This is the first and most commonly seen symptom of lumbar disc herniation. Patients experience a constant pain in the lower back, which intensifies with movement.
Pain radiating to the legs: The impact of a hernia can spread to the legs as a result of nerve root compression. The pain becomes particularly noticeable during prolonged sitting, walking, or bending. Some patients report that standing for long periods or lifting heavy objects exacerbates the pain.
Pain can restrict patients' daily activities and cause difficulty in movement. Patients sometimes describe the pain as feeling like an "electric shock". The intensity of the pain can vary throughout the day, becoming severe and sharp in some instances, while it may decrease in a resting position.
Another consequence of the pressure on the nerve roots is numbness and tingling in the affected area. This condition results from disturbances in nerve conduction. Numbness, depending on the nerve compressed by the herniated disc, is generally observed in the legs, feet, and sometimes also in the fingers.
Numbness and tingling in the legs: In cases of compression of large nerves such as the sciatic nerve, numbness is usually felt in the back of the leg and in certain areas of the foot. This sensation can sometimes be constant and may prevent patients from moving comfortably.
Numbness extending to the foot: In advanced cases of herniation, numbness can spread to the feet. Nerve compression can cause numbness in the top of the foot, toes, or sole of the foot. This sensation usually occurs together with pain, and patients may report "not feeling" part or all of their leg.
The sensation of tingling is usually caused by nerves being under pressure for an extended period. Patients describe this condition as feeling like "pins and needles" or "tingling" in their legs. Although numbness and tingling are generally the result of temporary impairment of the nerves, these symptoms can become permanent if the pressure on the nerves persists for a long time.
If a herniated disc exerts pressure on the spine and nerve roots for an extended period, it can lead to muscle weakness. Disruptions in the signals sent by the nerves to the muscles can cause weakening in the muscles. This weakness becomes particularly noticeable in the leg muscles, and patients may struggle to perform their normal activities.
Leg weakness: The weakness felt in the leg muscles can make it difficult for patients to walk, climb stairs, or stand for long periods. Some patients may experience a sudden loss of strength or a feeling of buckling in their legs. Weakness occurs as a result of muscle atrophy due to compression of the spinal nerves.
Weakness in the Legs: In cases of severe compression on the nerve roots, patients may become unable to lift their feet or place them properly on the ground. This condition, known as foot drop, arises when the nerves fail to transmit signals to the muscles of the foot. As a result, the patient may drag their foot on the ground while walking and may need to lift their legs higher than usual.
Weakness develops as a result of impaired function of the nerves compressed in the spine. If the pressure on the nerves is not relieved, weakness can increase further, and this situation can seriously affect the patient's quality of life. Loss of muscle strength can become permanent over time due to the deterioration of nerve functions, therefore early intervention is important.
Another significant symptom caused by lumbar disc herniation is limited mobility. Symptoms such as pain, muscle weakness, and numbness make it difficult for the patient to perform normal movements. Patients with lumbar disc herniation struggle with simple movements such as bending, twisting, and walking.
Difficulty in bending and twisting movements: A herniated disc restricts spinal movements, making it difficult for the patient to perform basic movements such as bending, flexing, or twisting. Patients may experience severe pain in the lumbar region [lower back] when attempting these movements.
Limitations in daily activities: Patients may struggle to perform even daily activities such as walking, sitting, and standing, depending on the intensity of the pain and the extent to which the nerves are affected.
Limited mobility due to lumbar disc herniation can negatively affect patients' work and social lives. As mobility restriction increases, patients tend to remain immobile, and this situation can lead to muscle weakness and general health problems.
The accurate diagnosis of lumbar disc herniation begins with the assessment of the patient's complaints and a comprehensive physical examination. Subsequently, in necessary cases, the exact location, size, and impact on the nerves of the herniation are determined using various imaging methods and nerve conduction studies. The methods used in the diagnosis of lumbar disc herniation are of great importance in determining the treatment plan.
The first step in diagnosing a patient presenting with suspected lumbar disc herniation is a detailed physical examination and listening to the patient's history. The doctor carefully inquires about the patient's pain and other symptoms (for example, numbness, tingling, muscle weakness), learning when the symptoms started, how they progressed, and which movements exacerbate them.
Patient's posture and mobility: The doctor observes the patient's posture and gait. In patients with herniated discs, deformities in the spine and lower back are commonly observed, and restrictions in the patient's movements can be noticed.
Testing of nerve functions: To evaluate the function of nerves, the patient's reflexes, muscle strength, and sensory functions are tested. The doctor attempts to understand which movements trigger pain and which nerve roots are affected by applying pressure to the lumbar region and legs.
Lasegue Test (Straight Leg Raise Test): This test is frequently used as a diagnostic test specific to lumbar disc herniation. The patient is asked to raise their leg straight while lying on their back. Pain felt in the lumbar region or the back part of the leg during this movement indicates pressure on the nerve roots. The Lasegue test is a highly sensitive test for detecting lumbar disc herniation and is generally used to determine compression of the sciatic nerve.
For the definitive diagnosis of lumbar disc herniation, radiological imaging methods are generally used. These imaging techniques display the structure of the spine and the pressure of the herniated disc on the nerves in detail. Below are the most commonly used imaging methods in the diagnosis of lumbar disc herniation:
Magnetic Resonance Imaging (MRI): MRI is the most preferred imaging method for the diagnosis of herniated discs. MRI allows for the clear visualization of soft tissues in the spine (discs, nerves, muscles). This method determines the location, size of the herniated disc, and the pressure it exerts on the nerve roots. MRI is also highly valuable in detecting other structural problems in the spine (for example, tumors, infections).
Advantages of MRI: MRI is a safe method that does not involve radiation and allows for the detailed examination of tissues such as the spine, discs, and nerve roots. Thus, it can clearly show how much the disc has herniated, the extent of pressure it applies on the nerve roots, and what kind of changes are present within the spinal canal.
Computed Tomography (CT): CT is utilized for the detailed examination of spinal bones. It is particularly effective in detecting abnormalities in the spinal bone structure or bone deformations resulting from disc herniation. It can be used in conjunction with MRI to determine whether a herniated disc is pressing on nerve roots.
Advantages of CT: CT provides a clearer visualization of bone structures. If there are structures such as bone spurs (osteophytes) along with disc herniation, CT is quite effective in imaging these structures.
X-ray: X-ray is used to view the general structure of the spinal bones but does not directly show a herniated disc. It can be utilized to detect misalignments in the spinal alignment, conditions such as scoliosis, or spondylosis. Although X-ray is often the first step in patients suspected of having a herniation, it needs to be supplemented with MRI or CT for a detailed visualization of the herniation.
Advantages of X-ray: One of the advantages of X-ray is its ability to quickly and easily visualize bone structures. Spinal alignment, intervertebral distance, and bone deformations can be detected with this method.
In addition to physical examination and imaging methods, electromyography (EMG) and nerve conduction studies can be used for a detailed evaluation of nerve functions. These tests demonstrate how effectively the nerves transmit electrical signals to the muscles and the degree of impairment in nerve functions.
Electromyography (EMG): EMG is used to measure the effectiveness of the signals sent by nerves to the muscles. During this test, small needles are inserted into the muscles, and the electrical activity in the muscles is recorded. The extent of the nerve roots' impact and the condition of muscle functions can be understood through this test. Since the pressure on the nerve roots due to a herniated disc can disrupt the signals going to the muscles, EMG can show the extent of nerve damage.
Nerve Conduction Studies: Nerve conduction studies measure how quickly and effectively nerves transmit electrical signals. This test is used to determine whether the nerves are under pressure and how this pressure affects nerve functions. If nerve conduction is slowed due to a herniation, this condition can be detected with these tests.
The treatment of lumbar disc herniation varies depending on the severity of the symptoms experienced by the patient, the extent of pressure on the nerve roots, and the patient's overall health condition. The primary goal of treatment is to alleviate the pressure on the nerves, control pain, and increase the patient's mobility. Most patients successfully recover with conservative treatment methods, however, surgical intervention may be required in severe cases.
A large portion of patients with herniated discs show improvement with non-surgical conservative treatment methods. These methods focus on alleviating the pressure created by the disc, strengthening the muscles, and reducing pain. Conservative treatments are generally preferred in the initial stage and are applied before surgical options.
Physical therapy is one of the most commonly used conservative methods in the treatment of lumbar disc herniation. Physical therapy programs consist of exercises aimed at strengthening the back and abdominal muscles and supporting the spine. These exercises reduce the pressure on the spine, thereby decreasing the patient's pain and increasing mobility.
The role of exercises: Physical therapy programs assist in strengthening the muscles that support the spine, thereby reducing the pressure on the spine. Stretching and strengthening exercises that fortify the muscles in the legs and lower back region enhance patients' mobility. Additionally, by teaching proper posture techniques, efforts are made to minimize stress in the lower back area.
Strengthening the back muscles: Strengthening the back and abdominal muscles is important to reduce the pressure on the spine caused by a herniated disc. These muscles provide additional support to the spine and prevent further herniation of the disc. This process specifically aims to prevent the patient from lifting heavy objects again or returning to incorrect postural positions.
Pain and inflammation are the most commonly encountered symptoms of lumbar disc herniation. Medication therapy is used to alleviate these symptoms. The medications used during the treatment process are determined by the doctor based on the patient's level of pain and overall condition.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These drugs are used to reduce pain and inflammation. NSAIDs (such as ibuprofen, naproxen) are generally effective in mild to moderate pain. These medications control pain by reducing the inflammation caused by pressure on the nerve roots.
Muscle Relaxants: Herniated discs can cause spasms in the muscles, which in turn increases pain. Muscle relaxants alleviate muscle spasms, providing relief. They help the muscles to remain in a more flexible and relaxed position.
Pain Relievers: For more severe pain, opioids (drugs similar to morphine) or stronger pain relievers like tramadol can be used. However, these types of drugs are generally recommended for short-term use because they carry a risk of addiction with long-term use.
Corticosteroid injections are another conservative method used in the treatment of herniated discs. These injections are administered directly to the areas around the spine and temporarily alleviate pain by reducing inflammation on the nerve roots.
Epidural steroid injection: Steroids reduce inflammation around the spine, facilitating the relaxation of nerve roots. These injections are typically administered to the nerve roots surrounding a herniated disc and their effect can last from several weeks to several months. Patients may experience significant pain relief during this period.
Surgical interventions in the treatment of herniated discs are employed when conservative (non-surgical) treatment methods are insufficient and the pressure on the nerve roots carries a risk of permanent damage. Surgical interventions are used to alleviate the pressure on the spine, preserve the function of the nerve roots, and eliminate severe pains that negatively affect the patient's daily life. Surgical treatment is generally preferred in the following situations:
The primary goal of surgical interventions is to eliminate the pressure on the nerve roots, restore nerve functions, and enhance the patient's mobility. The surgical methods commonly used in the treatment of lumbar disc herniation are detailed below.
Microdiscectomy is a minimally invasive surgical technique frequently used in the treatment of herniated discs. This method alleviates the pressure on the nerve roots by removing a small portion of the herniated disc. Microdiscectomy is particularly an effective treatment option in cases where the pressure on the nerve roots is concentrated at a specific point and disrupts nerve functions.
During a microdiscectomy, the surgeon makes a small incision of 2-3 cm on the patient's back. The surgery is performed with the aid of a microscope, which allows the surgeon to see the herniated disc and nerve roots in detail. With the help of the microscope, the surgeon carefully removes the part of the disc that is pressing on the nerve roots. During this procedure, the remaining intact part of the disc is preserved, and the operation is completed with minimal damage to the surrounding muscles, bones, and connective tissues.
Advantages of Microdiscectomy:
Disadvantages of Microdiscectomy:
Laminectomy is another common surgical method applied to alleviate the pressure on the nerve roots or spinal cord due to herniated discs. It is especially preferred in cases where the spinal canal is severely narrowed. This procedure involves the removal of a part of the vertebral bones (lamina) to widen the spinal canal and create more space for the nerve roots. Laminectomy is used in cases where nerve compression has advanced and conservative treatments have not been effective.
During the surgery, the surgeon removes a bone structure called the lamina, which is located at the back part of the vertebrae. This procedure expands the area where the nerve roots are compressed, thereby eliminating the pressure on the nerves. Since the laminectomy procedure generally covers a wide area, it provides significant relief along the spinal canal.
Laminectomy is particularly preferred in severe nerve compressions caused by spinal stenosis (narrowing of the spinal canal). In this method, the pressure on the nerve roots is quickly eliminated, and the patient feels significant relief after the surgery.
Advantages of Laminectomy:
Disadvantages of Laminectomy:
Disc prosthesis is one of the most modern methods used in the surgical treatment of herniated discs. This procedure involves the removal of the herniated disc and the placement of an artificial disc in its place. Disc prosthesis surgery is a method in which the herniated disc is completely removed, but the mobility of the spine is preserved. In traditional disc removal surgeries, spinal mobility is partially lost, whereas with disc prosthesis, this mobility is maintained.
During surgery, the surgeon completely removes the herniated disc and places an artificial disc into the spinal segment. This artificial disc is designed to mimic the natural mobility of the spine and maintains the mobility between the vertebrae. Artificial discs are usually made of metal and plastic, ensuring a balanced distribution of load between the vertebrae. The disc prosthesis prevents deformities in the spinal structure while preserving the spine's natural ability to move.
Advantages of Disc Prosthesis:
Disadvantages of Disc Prosthesis:
Herniated discs can largely be prevented through proper movement habits that reduce lifestyle and pressure on the spine. There are some basic measures to be taken to maintain spinal health and movement forms that should be paid attention to in order to prevent herniated discs. Although degenerative changes in the spine with age cannot be completely prevented, adjustments in lifestyle can significantly reduce the risk of herniated discs.
Proper posture is one of the most important factors in preventing lumbar disc herniation. Moving while preserving the natural curves of the spine reduces the pressure on the spine during prolonged sitting and standing, and ensures the discs function properly.
Regular exercise plays a significant role in preventing lumbar disc herniation. Strengthening the muscles that support the spine (especially the back and abdominal muscles) reduces the pressure on the spine and helps protect the discs. Additionally, exercises that maintain the flexibility of the spine increase the range of motion, thereby strengthening spinal health.
Heavy lifting is one of the most significant factors that increase the risk of herniated discs. Incorrect lifting techniques can apply sudden and intense pressure on the discs, leading to the tearing of the disc's outer layer and the leakage of the gel-like structure inside. Using correct lifting techniques can greatly reduce this risk.
Obesity and being overweight exert excessive pressure on the spine, increasing the risk of herniated discs. Particularly, excess weight accumulated in the abdominal area places additional load on the intervertebral discs, leading to their gradual deterioration over time. Controlling body weight is a significant factor in reducing the risk of herniated discs.
Smoking is one of the factors that negatively affect spinal health. Smoking prevents the discs from receiving an adequate amount of oxygen, leading to a weakening of the disc structure. Additionally, disc degeneration progresses more rapidly in smokers, and the risk of herniation increases.
To reduce the risk of herniated discs, it is important to regularly monitor spinal health. Regular doctor check-ups allow for the early detection of potential issues with the spine and the implementation of necessary precautions. Especially individuals experiencing lower back and back pain should not neglect regular check-ups related to spinal health.
Lumbar disc herniation, a common health issue due to the sedentary lifestyle brought by modern living, heavy physical labor, and improper posture habits, involves the deterioration of discs in the spinal structure and pressure on nerve roots, resulting in symptoms such as pain in the lumbar region, numbness in the legs, and muscle weakness. This condition can significantly restrict daily life activities and may lead to serious complications, including permanent nerve damage if not treated.
However, lumbar disc herniation can be managed with the correct treatment methods, and a significant portion of patients can show considerable improvement with conservative treatment approaches (physical therapy, medication, and lifestyle changes). In cases where surgical intervention is required, advanced surgical techniques (such as microdiscectomy, laminectomy, disc prosthesis) can restore patients' mobility and eliminate pain.
Early diagnosis is one of the most critical factors in the treatment of lumbar disc herniation. Patients encountering symptoms such as pain in the lower back and legs, numbness, and muscle weakness should seek a specialist without delay. Through physical examination and radiological imaging methods, lumbar disc herniation can be detected in its early stages, and the pressure on the nerve roots can be alleviated with appropriate treatment methods. In this process, exercises and lifestyle changes recommended by the doctor play a significant role in preventing the progression of the disease.
Preventing herniated discs is possible by patients paying attention to their spinal health. Adopting correct posture techniques, avoiding heavy lifting, engaging in regular exercise, and maintaining weight control reduce the risk of herniated discs. Additionally, quitting smoking and taking ergonomic measures are also effective in protecting spinal health.
The most important point that patients facing a herniated disc need to know is that this condition is treatable. Today, both non-surgical methods and surgical techniques have high success rates. Improving patients' quality of life and enabling them to return to their normal activities is possible with the right treatment plan. Long-term recovery of patients after treatment is achieved by adhering to doctor recommendations and continuing regular exercise.
In conclusion, being cautious against lumbar disc herniation, recognizing the symptoms early, and consulting a specialist are of great importance in preventing the progression of the disease. It is essential to remember that lumbar disc herniation is a manageable and treatable condition. With the correct treatment and rehabilitation process, patients can regain their quality of life. It is possible to minimize the risk of lumbar disc herniation with simple precautions and conscious movements in daily life.
