Herniated Disks- Lumbar Spine

by Keith M. Rezin, MD

Herniated disks in the lower back are a common condition typically in the 30 to 50 year old age group. It is estimated that up to 2% of the population will have a symptomatic herniated disk during their lifetime. The vast majority of people with back pain have a typical lumbar strain and not a true herniated disk. Typically individuals with a herniated disk will present with some degree of leg pain. This is known as "sciatica." In fact, it is not uncommon for patients to not have any back pain whatsoever. Depending on the disk that it is involved, you will get different symptoms going into the leg and these will correspond to the area of the nerve that is being compressed.

Current treatment typically would involve a short period of rest along with appropriate medications including a nonsteroid anti-inflammatory medicine, as well as a pain pill. Some individuals will get a Cortisone prescription, which is taken orally. Physical therapy and Epidural Steroid injections are also beneficial in some patients. Typically a 4-6 week course of conservative care is attempted prior to recommending anything surgically. At some point, further imaging studies are necessary and this is most likely done with an MRI.

If conservative care has failed for an approximate 6-week time frame and patients continue to have unrelenting pain, then surgical options should be considered. Utilizing micro-surgical techniques, a small incision of less than 1 to 2 inches can be made and the pressure on the nerve can be removed, again, under microscopic guidance. This minimally invasive procedure has greatly reduced post-operative pain and increased function. This procedure has become so commonplace that it is not uncommon for patients to go home on the day of surgery and no hospitalization is necessarily required.

Post-operatively, lifting and certain activities are restricted for up to 6 weeks. However, it is not uncommon for patients to have complete relief of their leg pain following surgery and only have a small amount of pain from their incision in the post operative course. The procedure is successful in greater than 90% of cases with a low risk profile.

If you think you have sciatica, you should consider an evaluation by your physician.