The building blocks of the spine are the "vertebrae". The discs are "shock absorbers" between these vertebrae. Each disc is a combination of strong connective tissues ring called the "annulus" and a gel-like center called the "nucleus". As we grow older, the center of the disc loses water content, making the disc less effective as a cushion. This may cause a displacement of the disc's center - a herniated or ruptured disc - through a crack in the outer layer.
As the herniated lumbar disc presses on the nerves in the spine it will cause pain, numbness, tingling or weakness down the leg called - "sciatica". Sciatica affects about 1-2% of all people, usually between the ages of 30 and 50. The leg pain pattern will vary depending on the level of disc affected and nerve trapped.
Sciatica often heals itself if you give it enough time and rest. Initial treatment is aimed at helping you to manage your pain without long-term use of medications. Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, aspirin or muscle relaxants may help. Local treatments like gentle heat or cold on your painful muscles can ease the acute pain. Physiotherapy is started as soon as pain allows.
The goals of nonsurgical treatment are to reduce the irritation and inflammation of the nerve and disc and to improve the physical condition of the patient to protect the spine and increase overall function. Steriods which have a strong anti-inflammatory effect can be delivered to the nerve as "epidural injections" or "nerve root blocks". The initial injection may be followed by one or two more injections at a later date, and should be done as part of a comprehensive rehabilitation and treatment program.
Should all this fail surgery may be indicated The surgery (discectomy)is done under general anesthesia and has a 90% chance of success for leg pain relief. This procedure can be done in a number of ways and the currently used technique in our practice is "Endoscopic Discectomy" which gives better visualisation at surgery but keeps the skin incision at a minimum. Following this surgery, you will probably be able to resume your normal lifestyle and keep your pain under control. Reherniation happens to about 5-7% of patients.
Cauda Equina - "Emergency disc herniation"
Rarely, a large sudden disc herniation may press on nerves and cause you to:
lose control of your bladder
lose control of your bowel
get numb round your private parts
get weakness in both legs
This situation that requires emergency surgery as these deficits may not be reversible. Phone your Doctor or A&E immediately.
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