CNY Orthopedic Sports Medicine, PC: InjuryDetail: Lumbar Disc Herniation
Injuries and Conditions: Back & Spine: Lumbar Disc Herniation: Medical Details
The anatomy of the spine is divided into three major regions. These regions are made up of bines known as vertebrae. Each vertebra within the spine is given a letter and number label that describes its exact location. The neck, or cervical spine, is designated by the letter "C" and contains seven vertebrae, numbered 1 through 7. The upper and mid-back represents the thoracic spine and each of the twelve vertebrae (numbered 1 through 12) are given the prefix of the letter "T".

The lower back, or lumbar spine, has five vertebrae identified with the number "L" and the numbers 1 through 5. For example, L4 means that the area of the spine being evaluated is the lumbar spine at vertebrae number 4. The sacrum, lowest level of the spine, contains vertebrae that have grown together and are usually referred to as one single structure.

The vertebrae of the cervical, thoracic, and lumbar spine are separated from each other by soft oval shaped cushions known as intervertebral discs. These discs are made up of a tough fibrous outer ring called the Annulus. These discs function in a similar manner to a shock absorber in a car and allow the spine to bend, flex, and twist while decreasing or dampening the force and stress that these movements place on the spine. The sacral spine does not contain intervertebral discs.

Three major regions of the spine:

  • Cervical spine (neck)
  • Thoracic spine (mid-back)
  • Lumbar spine (low back)

    Structures involved in a disc herniation

  • Intervertebral Discs: Pads of tissue between the vertebrae
  • Facet Joints: Joints which connect the back of the vertebrae to each other
  • Ligaments:Elastic bands that support and connect the vertebrae
  • Lamina: Arches of bone that form the roof of the spinal canal
  • Pedicles: Bones that form the walls of the sides of the spinal canal
  • Spinal Cord / Nerve Roots: Major electrical pathways of the Central Nervous System (CNS)
  • Spinal Canal: A tunnel of bone through which the nerve root and spinal cord pass

    The lumbar spine

  • The most common level for a lumbar disc herniation is L4-5 and L5-S.1.
  • The lumbar spine provides the foundation or support for the body standing erect.
  • The lumbar spine is made up of 5 vertebrae separated by soft, elastic intervertebral discs

    The intervertebral disc allows motion of the spine while also acting as a shock absorber and the connection link between each vertebrae. At each vertebral level a pair of spinal nerves exit the spinal canal through openings within the spinal column and between vertebrae called foramina.

  • Causes of Injury
  • Excessive weight, a sedentary lifestyle, and/or poor posture.
  • Normal degenerative changes, that reduce the strength and stability of the spine, making the spine susceptible to injury.
  • Improper lifting and moving techniques.
  • A sudden, strenuous and /or traumatic movement, which transmits a large amount of force on the spine.
  • Athletic activities that place a twisting force on the spine such as golf, baseball or tennis.

  • Diagnosis
    The signs and symptoms of a lumbar disc herniation can also mimic other spinal disorders. To confirm that the low back pain is due to a lumbar disc herniation, an appointment with an orthopaedic surgeon should be made. A complete history and physical exam should be obtained. The physical exam will include tests that measure, monitor, and evaluate nerve function.
  • The straight leg raise (Laseque's Sign)
  • The Bowstring Test
  • Wt. Relief Flexion Test

    Physical exam findings may strongly indicate the presence of a herniated disc, but to make an accurate and complete diagnosis, radiographic imaging studies may also be ordered.

    Radiographic imaging may include:

  • X-Ray films of the spine
  • Magnetic Radiographic Imaging (MRI)
  • CT Scan/Mylogram
  • Discogram

    If a lumbar disc herniation is determined to be the cause of the back pain an orthopaedic surgeon will review recommended treatment options with the patient.

  • Anatomy

     Product Considerations
    Lumbar: Supports
    A bad back can often be the result of poor posture and positioning. A lumbosacral back support, when properly fitted and positioned, will help to maintain a proper, stable posture when sitting at a chair or driving in the car. Poor posture while sitting forces the spine out of its proper position and puts a significant strain on the muscles, tendons and ligaments that support the spine. Lumbar supports can be found in a wide range of sizes and styles.

    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.

  • Hot/Cold Pack
    The use of hot and cold packs to relieve pain and inflammation is a common method of treatment for many conditions. When the soft tissue groups become strained or irritated the rotating application of hot and cold can be beneficial. Cold therapy numbs the nerves to reduce pain and combats swelling by constricting blood vessels and by slowing blood flow to the site of injury. The application of heat to an injury after a few days of cold therapy and after swelling and redness has been reduced promotes the healing process. Heat therapy speeds up healing by increasing the flow of blood to the site of injury. Heat will also restore flexibility, relieve muscle cramping, and arthritic symptoms.

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