Lumbar disc herniation is a fairly common spinal issue that occurs in approximately 1-3% of people. It is often found in middle-aged patients aged 40 years and older, and it occurs in men more frequently than in women, at a ratio of 60% to 40% respectively. This condition is caused by the damage or deterioration of intervertebral discs due to age, genetics, and usage. Once deterioration has occurred, a disc can rupture leading to some of the nucleus pushing out and pressing on the nerves.
1. Most patients experience symptoms of back or hip pain radiating down the leg. There may also be some numbness or weakness as well.
2. Fairly sudden back pain that radiates down the leg may occur after heavy lifting, bending over, or falling down.
Diagnosis is based on the patient’s medical history, a physical examination, and an x-ray examination, as well as magnetic resonance imaging (MRI).
Some patients may be able to be treated without surgery by using the following methods:
- Resting for short periods of time throughout the day and avoiding heavy lifting, bending over frequently, sharp twisting movements, and sitting for long periods of time.
- Use of medications to reduce inflammation and lessen nerve pain.
- Physical therapy can also be helpful.
- In the case of minor lumbar disc herniation where the pain is not severe, an injection of medication into the area around the spinal nerves can also be used to help reduce inflammation and pain.
Some patients do not improve with non-surgical treatment. Of these, about 1/3 of patients require surgery. Surgery to remove the protruding part of the disc. At present, a minimally invasive lumbar discectomy can be carried out. There are two main methods for doing this.
- Endoscopic discectomy, in which an incision of about 1 cm is made and an endoscopeis inserted to assist the doctor in surgery.
- Microscopic discectomy, whereby an incision is made and a microscope is used to assist in surgery.
- Avoid lifting heavy objects, bending over frequently, or intense twisting movements.
- Avoid sitting for longer than 30-60 minutes at a time.
- Avoid smoking.
Compiled by Dr. Pritsanai Pruttikul
Orthopedic and spinal surgery specialist
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