The vertebral column, also called the backbone, is made up of 33 vertebrae that are separated by spongy disks and classified into four distinct areas. The cervical area consists of seven bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of five bony segments in the lower back area; five sacral bones (fused into one bone, the sacrum); and four coccygeal bones (fused into one bone, the coccyx).
Lumbar disk disease occurs in the lumbar area of the spine. The lumbar area of the spine (and other areas of the spine) is made up of two parts, including the following:
The vertebral bodies are numbered from 1 to 5 in the lumbar spine and the discs are located between two of the vertebral bodies and are numbered accordingly (such as a disc at L2-3, or between the lumbar disks numbered 2 and 3).
The intervertebral disc is composed of two parts, including the following:
As we age, the intervertebral disk may lose fluid and become dried out. As this happens, the disk compresses. This may lead to the deterioration of the tough outer ring allowing the nucleus, or the inside of the ring, to bulge out. This is considered a bulging disk.
As the disk continues to degenerate, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is considered a ruptured, or herniated, disk. The fragments of disk material can then press on the nerve roots that are located just behind the disk space. This can cause pain, weakness, numbness, or changes in sensation.
Most disk herniations happen at the lower lumbar spine, especially at the L4-5 and L5-S1 levels.
Lumbar disk disease is due to a change in the structure of the normal disk. Most of the time, disc disease comes as a result of aging and the degeneration that occurs within the disk. Occasionally, severe trauma can cause a normal disk to herniate. Trauma may also cause an already herniated disk to worsen.
The symptoms of lumbar disk disease vary depending on where the disk has herniated, and what nerve root it is pushing on. The following are the most common symptoms of lumbar disk disease. However, each individual may experience different symptoms. Symptoms may include:
The symptoms of lumbar disk disease may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for lumbar disk disease may include:
Specific treatment for lumbar disk disease will be determined by your health care provider based on:
Typically, conservative therapy is the first line of treatment to manage lumbar disk disease. This may include a combination of the following:
When these conservative measures fail, surgery for removal of a herniated disk may be recommended. Surgery is done under general anesthesia. An incision is placed in the lower back over the area where the disk is herniated. Some bone from the back of the spine may be removed to gain access to the area where the disk is located. Typically, the herniated part of the disk and any extra loose pieces of disc are removed from the disc space.
After surgery, restrictions may be placed on your activities for several weeks while healing is taking place to prevent another disk herniation from occurring. Your surgeon will discuss any restrictions with you.
There are other experimental therapies that are being used to treat lumbar disk disease. Discuss these treatment options with your health care provider.
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Online Resources of Nervous System Disorders