A disc herniation is the displacement of any of the 23 naturally occurring disks in the vertebral column, caused by a lifetime of stress on the neck or back, a sudden traumatic event, or both.
While disk herniations can cause neck or back pain if they are severe, they more often cause arm or leg pain, numbness, or weakness from compression of a nerve. In extreme circumstances, a disc herniation can cause paralysis or bowel and bladder incontinence.
As shown in the Figure, lumbar disk herniations can be referred to a “bulges” if they are small and inconsequential, or “extrusions” if they are large and compressing a nerve.
Figure: From left to right, a lumbar disc bulge, herniation, and extrusion.
Studies indicate that the vast majority of symptomatic lumbar disc herniations improve within several weeks, as the disk is reabsorbed naturally by the body. Conservative nonsurgical therapies such as steroids, nonsteroidal anti-inflammatories, narcotic analgesics, epidural steroid injections, and physical therapy can sometimes help patients with their pain as this happens.
Lumbar microdiscectomy should be considered for patients with
- Neurological deficits such as weakness, difficulty walking, or bowel/bladder incontinence
- Severe pain that does not respond to medications, or
- Symptoms that persist in spite of several weeks of conservative therapies
For patients with herniated discs and lumbar instability, the discectomy may be followed by a lumbar fusion procedure such as an ALIF, PLF, PLIF, TLIF, or XLIF along with minimally invasive lumbar instrumentation with screws and rods.