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Lumbar Disk Herniation
Lumbar Disc Protrusion

Presentation

Leg pain continues to be the primary presenting symptom in this group of patients and is often not recognized as the radicular pain of a herniated disk by the primary care physician. [ncbi.nlm.nih.gov]

A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. [nejm.org]

Entire Body System

  • Pain

    For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. [ncbi.nlm.nih.gov]

    […] or induce severe back pain instead of relief. [scielo.br]

  • Weakness

    We calculated the 1- and 2-year prevalence of patient-reported persisting weakness or sensory deficits. [ncbi.nlm.nih.gov]

    This can cause pain, weakness, numbness, or changes in sensation. [hopkinsmedicine.org]

    The abnormal disk material can place pressure on the adjacent spinal cord or nerve roots, resulting in pain, numbness, or weakness in areas of the lower back, buttocks, and legs. [jamanetwork.com]

  • Falling

    I had a fall in 2014. I was down at our waterfront,… Submit an appointment request on our patient portal or contact our New Jersey and Pennsylvania campuses to speak with a patient advocate. [princetonbrainandspine.com]

    If you have had a discectomy or if your doctor has recommended one because of an injury from a car accident, pedestrian accident, bicycle accident, or fall that was caused by someone else’s wrongdoing, you may have a claim to receive monetary compensation [jimdodsonlaw.com]

    This happens naturally in the process of aging, but can also happen prematurely as a result of various factors, such as trauma (car accidents, falls), repetitive injury from certain occupations or sports, or even genetic factors. [neurosurgery.wustl.edu]

    Typically, a herniated disk is suspected after an individual falls or has been involved in an accident involving the back. [thespinehealthinstitute.com]

    We describe a case of a 40-year-old female who presented to us with pain lower back, pain in both lower limbs and urinary retention after a fall. [read.qxmd.com]

  • Arm Pain

    Epidural Injections Epidural injections are used to treat pain that starts in the spine and radiates to an arm or leg. Arm or leg pain often occurs when a nerve is inflamed or compressed ("pinched nerve"). [orthoinfo.aaos.org]

    Varying levels of a disc herniation VARYING LEVELS OF A DISC HERNIATION Specifically, a disc fragment in the neck that pinches a nerve to the arm would cause arm pain, whereas in the low back a piece of disc that breaks off and pinches a lower extremity [spinemd.com]

    C3 Injury to spinal bone three often causes pain, tingling, and sometimes numbness in the arms, neck, and head. [disabled-world.com]

  • Finger Pain

    […] moving your neck Deep pain near or over your shoulder blade Radiating pain in your upper arm, forearm, and possibly your fingers Pain from a bulging disc may start slowly and get worse over time or during certain activities. [depuysynthes.com]

    C7 Nerve - neck, shoulder, middle finger pain are common, along with the index, middle finger, and palm numbness. [physio-pedia.com]

Respiratoric

  • Sneezing

    This can happen when you cough, sneeze or sit down. Watch this video what are the treatment for Slip disc / Nerve Compression. Careworldtv Channel is the #1 destination for Fitness & Lifestyle content on YouTube. [youtube.com]

    Smoking—deprives blood flow and nutrients needed for disk repairs History of back injury, previous herniated disk, or prior back surgery A moderate injury causes immediate numbness or weakness in one or both legs You have shooting leg pains with coughing, sneezing [jamanetwork.com]

    Pressure from a sneeze, cough or laugh increases the pressure in your spine and can make the pain in your back unbearable. [expertbeacon.com]

    All 35 patients were diagnosed with lumbar disc herniation by an orthopedist or neurologist and had lower back pain and sciatica that they described as increasing pain or an electrical feeling when coughing and sneezing. [practicalpainmanagement.com]

    Even coughing, sneezing, and sitting can aggravate your symptoms because they put pressure on the pinched nerves. Age also plays a factor. As you get older, your disks tend to break down and lose their cushioning. [webmd.com]

  • Cough

    This can happen when you cough, sneeze or sit down. Watch this video what are the treatment for Slip disc / Nerve Compression. Careworldtv Channel is the #1 destination for Fitness & Lifestyle content on YouTube. [youtube.com]

    […] vibration Smoking—deprives blood flow and nutrients needed for disk repairs History of back injury, previous herniated disk, or prior back surgery A moderate injury causes immediate numbness or weakness in one or both legs You have shooting leg pains with coughing [jamanetwork.com]

    Pressure from a sneeze, cough or laugh increases the pressure in your spine and can make the pain in your back unbearable. [expertbeacon.com]

    All 35 patients were diagnosed with lumbar disc herniation by an orthopedist or neurologist and had lower back pain and sciatica that they described as increasing pain or an electrical feeling when coughing and sneezing. [practicalpainmanagement.com]

    […] temperature might increase during the therapy Acute Inflammation Infectious diseases Certain forms of cancer certain skin conditions Certain cardiac problem Haemorrhagic disorders Diarrhoea Acute illness Extreme fatigue severe abdominal pain Chronic cough [healingearth.co.in]

Gastrointestinal

  • Constipation

    Very large disc herniations may result in urinary difficulty and constipation. In cervical disc herniation, the spinal cord as well as the nerve roots may be compressed. [uclahealth.org]

    Constipation is a common side-effect from codeine. This may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre. [patient.info]

    Side effects include sedation, nausea, and constipation. Epidural steroid medication (injected into the space just outside of the sac of spinal fluid), reduces swelling, inflammation, and pain. [innerbody.com]

    When digestion is weak or constipation present, even those beans listed under small amounts should be avoided. Mung beans, Aduki beans, red lentils, black gram, black lentils, pinto, soy beans, tofu. Yellow lentils, chick peas, kidney beans. [ayurvedabodycure.com]

  • Fecal Incontinence

    If the anal sphincter is not working, fecal incontinence may occur. This means the patient loses the ability to control the passage of stool from the bowels. If the urethral sphincter is not working properly, urine leaks from the bladder. [livestrong.com]

    incontinence as well as sexual dysfunction. [physio-pedia.com]

Eyes

  • Prolapse

    Any disc in the spine can prolapse. However, most prolapsed discs occur in the lower back (the lumbar spine). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be. [patient.info]

    However, little is known about acute disc prolapse in the elderly. OBJECTIVE: We aimed to define the features of acute disc prolapse in the elderly. [read.qxmd.com]

    The improvements were even more marked in patients with protrusion or prolapse type herniation. [ncbi.nlm.nih.gov]

Musculoskeletal

  • Back Pain

    “Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain. [jaoa.org]

    The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity. [ncbi.nlm.nih.gov]

  • Low Back Pain

    “Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain. [jaoa.org]

    The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity. [ncbi.nlm.nih.gov]

  • Spine Pain

    Thoracic disc herniation presents most commonly as chest pain or spine pain, and occasionally in numbness, weakness, or spasticity. [uclahealth.org]

    Low back pain and/or leg pain (sciatica) are the most common symptoms of a herniated disc in the lumbar (lower) spine. Pain may vary from mild to severe. [treatingpain.com]

    […] the waist down Bulging disc in your cervical spine: Pain moving your neck Deep pain near or over your shoulder blade Radiating pain in your upper arm, forearm, and possibly your fingers Pain from a bulging disc may start slowly and get worse over time [depuysynthes.com]

    It can help lessen the pain by strengthening the muscles that support your spine. [patient.info]

  • Foot Pain

    This causes buttock, leg, and foot pain or numbness, often referred to as sciatica. The symptoms are usually worse with sitting than most other positions as sitting typically causes more tension on the lower spinal nerve roots. [emoryhealthcare.org]

    When pinched, sciatic pain may be experienced anywhere along these branches, radiating from the buttocks down the back of the leg and sometimes through the shin and foot. Often, leg pain occurs without any back pain. [treatingpain.com]

    This weakness is called foot drop. Numbness and pain may be felt on top of the foot, and the pain may also radiate into the buttock. [spine-health.com]

    (which addresses leg or foot pain, numbness and tingling on a scale from 0 to 30), the NASS function subscale (which addressed disability because of pain on a scale from 0 to 45), the SF-36 V.1 physical and mental subscales (scale from 0 to 100)29 and [bmjopen.bmj.com]

  • Acute Low Back Pain

    Familial predisposition to discogenic low-back pain. An epidemiologic and immunogenetic study. Spine. 1988;13:1403–6. 6. Bigos SJ. Acute low back problems in adults. Rockville, Md.: U.S. [aafp.org]

    DC, PT: Comparison of Classification-Based Physical Therapy With Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain: A Randomized Clinical Trial. Spine. 2813:1363-1371, July 1, 2003. [hss.edu]

    Spinal Manipulative Therapy and Mobilization - Spinal manipulative therapy and mobilization leads to short-term pain relief when suffering from acute low back pain. [physio-pedia.com]

Urogenital

  • Incontinence

    Thus, two factors can cause urinary incontinence with a lumbar disc herniation. [livestrong.com]

    True indication for surgery is incontinence and/ or rapidly progressing paralysis of the extremities over a short time. If you have been told you need surgery for a disc herniation, let this study encourage you that time may on your side. [drkevinpauza.com]

    Common symptoms of lumbar disc protrusion include: Chronic low back pain Pain, numbness and tingling in the legs, feet and toes Back stiffness or soreness Muscle weakness in the thighs and calves Sciatica Incontinence (in rare emergency cases) If you [laserspineinstitute.com]

  • Urinary Incontinence

    Thus, two factors can cause urinary incontinence with a lumbar disc herniation. [livestrong.com]

    In some cases the person may experience urinary incontinence. Another condition is Sciatica. The herniation of the disc in the lumbar region is the major cause. This puts pressure on the Sciatic nerve. [wellnessloka.com]

    In the most severe cases, a herniated disk can compress nerves that control the bowel and bladder, causing urinary incontinence and loss of bowel control. Scientists do not fully understand why disks herniate. [womenshealthmag.com]

Neurologic

  • Sciatica

    Ng and Sell 45 proposed a threshold for the duration of sciatica of 12 months. Some of the reported thresholds of the duration of sciatica, which is associated with poor outcome, are listed in Table 3. [healio.com]

    Sciatica is a common diagnosis in the general population. Sciatica is most frequently caused by LDH. [sogacot.org]

    Sciatica due to a herniated lumbar intervertebral disk is common and has an estimated point prevalence of roughly 5% in the general adult population.1 Numerous prospective studies have reported excellent recovery of acute sciatica in the absence of significant [cmaj.ca]

    Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. [ncbi.nlm.nih.gov]

  • Paresthesia

    A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. [nejm.org]

    CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. [ncbi.nlm.nih.gov]

    His history was significant only for a spontaneous onset of lumbar back pain noted immediately after awkward bending six months prior, followed two to three days later by severe leg pain, paresthesias and ankle weakness, consistent with an L5 radiculopathy [cmaj.ca]

  • Foot Drop

    Foot drop is defined as inability to dorsiflex the foot at the ankle joint. [ncbi.nlm.nih.gov]

    Neurological symptoms caused by the herniation may include difficulty lifting the foot when walking or standing on the ball of the foot, a condition known as foot drop. See What Is Foot Drop? Article continues below Lower back pain. [spine-health.com]

    In those with severe extensor weakness, especially painless foot-drop, diskectomy does not improve the outcome.” Discrimination between foot drop and severe extensor weakness may not be possible or reasonable. [healio.com]

    […] w/ or w/o surgery; - of all patients who sustain acute sciatica, less than 25% will require surgery; - despite the generally good prognosis, some patients will not recover such as this patient who had chronic anterior compartment atrophy and a mild foot [wheelessonline.com]

  • Headache

    This can cause pain to shoot down the arms, as well as headaches in the back of the head. Although severe pain and discomfort often accompany a herniated disk, it can be challenging for a physician to identify the cause. [thespinehealthinstitute.com]

    It is more invasive than MRI and may produce effects such as headache, but in some cases may be essential in defining the anatomy. Treatment: Bed rest and non-steroidal medications often produce relief of acute forms. [uclahealth.org]

    The risks of spinal injections include, but are not limited to the following: Bleeding Infection Nerve injury Arachnoiditis Paralysis Avascular necrosis Spinal headache Muscle weakness Increased pain Common side effects from steroids include: Facial flushing [orthoinfo.aaos.org]

    Neck pain, headaches and pain in the face, shoulders, arms and hands may be created when the disc protrusion or “Slipped Disc” presses on the neck nerves. [spinal-foundation.org]

    Complications include bleeding, headaches, infections, and very rarely, injury to a nerve. However, pain reduction can be markedly improved. Studies have shown excellent pain reduction and return to function with the use of epidural injections. [hss.edu]

  • Paresis

    […] of the magnitude of the paresis. [healio.com]

    At the examination he showed severe motor paresis and absent reflexes of his lower limbs, while crural pain was mild and sensation and urinary function were unaffected. [ncbi.nlm.nih.gov]

    A case The patient had as its main symptom radicular pain, to the examination physical presented paresis and, sensitive alteration in the root territory committed in the affected lower extremity. [fortunejournals.com]

Workup

[…] invasive Plain lumbar films: Generally not helpful in the diagnosis, except to rule out other diseases and to evaluate for possible skeletal etiology as the cause of the patient's symptoms Bone scanning: To rule out tumors, trauma, or infection See Workup [emedicine.medscape.com]

X-Ray

  • X-Ray Abnormal

    Abnormal movements of the vertebrae can be identified if X-rays are made while the patient is bending forward or leaning backward. [thesteadmanclinic.com]

Treatment

In group A, treatment was a success (excellent or good outcome) in 70.3% and deemed a failure (poor outcome or recourse to surgery) in the remaining 29.7%. In group B, treatment was a success in 78.3% and deemed a failure in the remaining 21.7%. [ncbi.nlm.nih.gov]

However, since Weber 2 published his landmark paper in 1983, the pendulum with regard to the best treatment for LDH has shifted from surgery toward nonsurgical treatment options. [healio.com]

Postoperative treatment and follow-up visits The routine postoperative anti-inflammatory treatment with a glucocorticoid and dehydration treatment with mannitol was followed for 5-7 days. [scielo.br]

Prognosis

In patients with chronic or recurrent disk herniation, the prognosis for recovery from pain or dysfunction is often poor. [ncbi.nlm.nih.gov]

Please suggest me the best possible treatement and the prognosis. [practo.com]

used to diagnose L5 and S1 radiculopathy; - femoral stretch test: used to diagnose L4 radiculopathy; - this test is performed by raising the leg while the patient is prone; - wt relief flexion test: - MRI of Disc Herniation : - Natural History: - prognosis [wheelessonline.com]

Prognosis for sphincter recovery after operation for cauda equina compression owing to lumbar disc prolapse. Br Med J (Clin Res Ed). 1981; 282(6279):1852-1854. Tay EC, Chacha PB. [healio.com]

Etiology

Abstract The authors have retrospectively studied the trends in etiology, symptoms, and rate of recurrence for adolescents with disk herniations to determine the age at onset of symptoms, mechanism of injury, familial history, pattern of symptoms, level [ncbi.nlm.nih.gov]

Discal etiology can be suggested by clinical observation in patients complaining of classical lower back pain, but not excluded even without musculoskeletal pain. [read.qxmd.com]

Potential Etiologies Lumbar disc herniations can occur as a result of direct trauma or gradual degeneration over time. [morphopedics.wikidot.com]

[…] scanning: Useful but less sensitive than MRI Myelography: May provide definitive diagnosis itself, but technique is invasive Plain lumbar films: Generally not helpful in the diagnosis, except to rule out other diseases and to evaluate for possible skeletal etiology [emedicine.medscape.com]

Epidemiology

It is important for both patients and spine surgeons to understand epidemiology trends and outcomes of revision surgery for real recurrent lumbar disk herniation (real-RLDH). [ncbi.nlm.nih.gov]

An epidemiological study of the relationship between occupations and acute herniated lumbar intervertebral discs. Int J Epidemiol 1975;4:197-205. [ PUBMED ] 37. Stairmand JW, Holm S, Urban JP. [dx.doi.org]

Epidemiology of spinal disorders. In: Frymoyer JW, Ducker TB, Hadler NM, et al., eds. The adult spine: principles and practice. New York: Raven Press, 1997:93–141. 5. Heliovaara M. Epidemiology of sciatica and herniated lumbar intervertebral disk. [aafp.org]

Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg AM. 2006;88(2):3-9. Institute for Quality and Efficiency in Health Care (IQWiG). Slipped disk: overview. 2014; n.pag. [paindoctor.com]

Epidemiology The lifetime prevalence of low back pain is 80%, with disk disorders being the most common cause of adult low back pain. [emedicine.medscape.com]

Pathophysiology

Abstract To better understand the pathophysiologic mechanisms underlying spinal nerve root injury induced by lumbar disk herniation (LDH), comparative proteomic analysis of cerebrospinal fluid (CSF) between patients with LDH (the experiment group) and [ncbi.nlm.nih.gov]

Pathophysiology The disc consists of the annulus fibrosus (a complex series of fibrous rings) and the nucleus pulposus (a gelatinous core containing collagen fibers, elastin fibers and a hydrated gel)[10]. [physio-pedia.com]

To obtain more insight into the pathophysiology of the disease, several association and candidate gene analyses have been performed. [asbmr.onlinelibrary.wiley.com]

Prevention

It is essential to pay careful attention to prevent a dural tear. Patients may expect clinical outcomes similar to those following primary discectomy. [ncbi.nlm.nih.gov]

Another important step for preventing disk issues is changing positions frequently throughout the day. Sitting or standing in the same position for long periods can irritate a disk injury. [medicalnewstoday.com]

Cleaning up the intervertebral disc tissue within the intervertebral space is an effective way to prevent recurrence, but excessive removal should be avoided to prevent significantly decreasing the height of the vertebrae interval. [scielo.br]

Prevention Techniques for proper lifting, sitting, standing, and posture may prevent herniated discs. When lifting heavy objects, people should use their leg muscles instead of their backs and avoid twisting while lifting. [innerbody.com]

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