Daniel K. Park, MD

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Lumbar Herniated Disc

Lumbar herniated disc (HNP) can lead to what is commonly called "sciatica". The lumbar spine consists of the bone, "vertebrae," and in between the vertebrae are discs. The discs can be thought of as the "shock absorbers" or "cushions" between the vertebrae. The disc is made up of a fibrous, tough, outer ring (the annulus) surrounding a central core of gelationous, soft material (the nucleus). If the annulus tears, the nucleus can then extrude through a hole in the annulus and place pressure on a spinal nerve root. This is similar to what would happen if a jelly doughnut is crushed; the jelly will leak out through the side of the doughnut. This is what is called a "herniated disc."

Typically, the herniated disc irritates the sciatic nerve, which is the longest nerve in our bodies. It begins in the lower back and extends through the buttocks down the back of each leg to the thighs and feet.

Sciatica or HNP can be acute (short term) lasting a few weeks, or chronic (long term) persisting for more than 3 months. It is important to understand that most HNP will resolve itself within a few weeks or months and rarely causes permanent nerve damage.

Anyone can develop HNP at some point in their lives; however there are certain risk factors that may predispose you to developing sciatica. These include the following:

  • Increased age
  • Poor physical fitness or inactive lifestyle
  • Occupational risks
  • Genetics
  • Poor nutrition
  • Medical conditions such as diabetes or cancer that has metastasized to the spine can cause sciatica
  • Smoking

The most common symptom of HNP is pain. The pain can vary by patient, from mild to debilitating, depending on the degree of pressure to the spinal nerve. Common symptoms of HNP include:

  • Pain in the buttock area and leg
  • Sharp, intense, shooting pain down the leg
  • Numbness, burning or tingling to the leg or foot
  • Weakness of the leg or foot
  • Low back pain that radiates down to the buttock and leg
  • Pain increases with coughing, sneezing, or straining
  • Pain increases with bending backward
  • Pain intensifies with prolonged sitting or standing

HNP will be diagnosed by taking complete medical history, physical examination, assessment of neuromuscular function, and diagnostic procedures such as X-ray, MRI, CT scan, CT scan with myelogram, electromyogram, and nerve conduction tests.

HNP can be treated with conservative treatment approaches such as physical exercises, over the counter drugs, ice or hot packs, prescription medications, epidural steroid injections, massages, and manual manipulation. In some cases surgery may be recommended to treat the herniated disc material. The entire disc is not removed, but the part that is damaged is removed.

Lumbar Microdiscectomy

Clinical Example

History: 32 year old male comes to the office with left side leg pain. He states the pain increases with sitting for long periods of time and states his pain is not getting any better. His troubles started 3 months ago. It aggregates him when he tries to straight out his legs.

Images: A MRI was taken which demonstrated a large disc hernation at L5-S1. This image is a cross sectional image. The arrow points to a large herniation that is compressing the nerve trying to exit the spinal canal on the left side.

Herniated Disc

Surgery: Patient underwent minimally invasive surgery to remove the disc hernation.