Integrated Pain Management


Lumbar disc herniation…

or a lumbar ruptured disc is a common cause of lower back pain. Between each of the 5 lumbar vertebrae, there is a disc which is a fibrous pad for absorbing shock.

There are end plates at the end of each vertebra to hold the disc in place. Each of the discs is made up of an outer annulus fibrosus band which is tire-like and encases the nucleus pulposus, a gel-like substance.

Lumbar disc herniation

Lumbar disc herniation will occur when the annulus fibrous is broken or cracked and this allows the escape of the nucleus pulposus.

This breakage/crack and leak is what is referred to as a herniated disc. In some cases, this condition is referred to as a bulging disc or a ruptured disc.

All along the spine, there are nerves which branch from the spinal cord. These travel to different parts of your body to help in moving and feeling.

When the disc is herniated, it may press these spinal nerves or the spinal cord. When the nerves or the spinal cord are compressed, this may result in the pain that is associated with lumbar disc herniation.


A large number of herniation cases occur in the bottom area of the spine mostly at the L5-S1 or the L4-L5 area. Common symptoms may include sharp pain, muscle cramping or spasm, and weakness or loss of the function of the leg. Coughing, sneezing and bending can intensify the pain. This condition is associated with common sciatica symptoms which are

> Constant pain in one side of the leg or buttock and in some rare cases, both sides. 

> Pain that disappears when the patient is walking or when they lie on their back but worsens when they stand or sit. 

> Pins and needles sensation, prickling sensation, weakness or numbness down the leg. 

> Lower back pain experienced but not as severe as the pain in the leg. Pain described as being searing or sharp as opposed to dull. 

> Pain emanating from the buttocks or lower back and radiates along the sciatic nerve all the way to the back of the thigh then down to the lower part of the leg and finally to the foot.

In some cases, the control of bladder and bowel is lost and this should be addressed by a medical practitioner immediately.



Risk Factors

There are many different factors that have been found to increase the risk for lumbar disc herniation. 

The following are the major factors:

Women are known to have low back pain which is associated with conditions that affect their reproductive systems such as ovarian cysts, endometriosis, uterine fibroids or ovarian cancer.

About 50% of pregnant women experience low back pain which is as a result of change in posture, and muscle and ligament strain cause by the position of the center of gravity. There are four main categories of low back pain. These are:


Things such as lack of regular exercise, use of tobacco, and poor nutrition can lead to deterioration of disc health. 

Poor Posture

The combination of a poor posture and incorrect body mechanics can stress the lumbar spine and affect its ability to handle the weight of the body. 


As the body ages, there are biochemical alterations which may lead to the drying of the disc and this can affect its resilience and strength. In simple terms, as a person ages, the intervertebral disc become weaker and incapable of absorbing the shock resulting from the individual’s movement and this is their main job.

All these factors combined with daily wear and tear, twisting, or lifting can lead to herniated discs. Lifting something incorrectly can increase the pressure on the discs and this can lead to a crack or a breakage.

The Herniation of a Lumbar Disc

A disc herniation may occur suddenly, but in most cases it happens gradually over time. Below are the four stages of a disc herniation:

Disc Degeneration

This is a stage where chemical changes connected to the aging process render the disc week but without herniation. 


The position or the form of the disc changes with a minor impingement into the spinal nerve and/or spinal canal. This stage is also referred to as a protruding or a bulging disc.


In this stage, the gel-like substance referred to as nucleus pulposus breaks the tire like band called annulus fibrosus but does not go out of the disk.

Sequestered Disc or Sequestration

This is where the nucleus pulposus breaks through the annulus fribrosus and moves outside the intervertebral disc and can compress nerves and the spinal cord.


An interesting medical fact is that not all lumbar herniated discs will have symptoms. There have been many reported cases of people who have only discovered that they have a bulging disc after an x-ray done for a different condition or reason.

In most of the reported cases, the symptoms associated with lumbar disc herniation, especially the pain are what drive the patients to seek medical attention.

Diagnosis of herniated discs includes neurological and physical exams. The medical practitioner will go through the patient’s medical history, ask about the symptoms experienced and the treatments that have been tried. X-rays are used in ruling out any other condition that might be causing the pain such as osteoarthritis also called Spondylosis, or Spondylolisthesis. An MRI or CT scan can show soft tissues and thus can be used in the verification of the location and the extent of the damage on the disc.


In most cases, the pain may disappear or get better in a period of 6 months. There are several methods of management that are recommended as the patient waits or the 6 weeks. These methods are aimed at alleviating the pain and enhancing healing.

The non-surgical methods include:

  1. > Ice and/or heat therapy 

  2. > Physical therapy Non-steroidal anti-inflammatory drugs 

  3. >Epidural injections 

  4. > Oral steroids 

  5. > Manual manipulation.

If the symptoms and the pain do not go away after 6 weeks, surgery becomes a viable option.


Microdisectomy is the surgery used in taking the pressure off the nerve and give it a better environment for healing. Only a portion of the disc pushing the nerve is removed while the rest remains intact.

This surgery can be conducted on an outpatient basis especially because there is technology that allows for microsurgery through tiny incisions. This minimal invasive method will correct the situation and the patient will be ready to continue with normal activities in less than three weeks.

In case of any symptoms or pain around the lower back area, it is important that an individual seeks medical attention for proper diagnosis and treatment that will get rid of the symptoms and address any other underlying factors.