Lumbar diseases are among most common conditions of our era; affecting work life, strength and quality of life. Eighty percent of the people experience low back pain and present to a physician at least once in their life.

Low back region is a part of our body that bears heaviest loads. Lifting heavy weights, working at a sitting position for an extended period of time, poor posture, and insensibly or reckless exercising deteriorates lumbar anatomical structures, resulting in lumbar diseases. The most common conditions are lumbar hernia, mechanical low back pains and slipped vertebra (spondylolisthesis).

There are 24 vertebras in our body and they are arranged from the neck to the coccyx to form the spinal canal. There are five vertebras in the lumbar part of the spine; they are surrounded by connective tissue and muscles. A cartilage tissue called discs is present between vertebras; the discs act as shock absorbers, facilitate movement between vertebras and ensure flexibility of the lumbar spine. The disc consists of two parts, inner (nucleus) and outer segments. When the outer layer is damaged, the inner nucleus overflows. The overflowing or bulging part compresses the nerves in the spinal canal. This condition is called Lumbar Hernia.

Who are affected from lumbar hernia? Who are at risk?

It is more commonly in middle aged people, but it may develop at any age. Manual laborers who carry heavy weights or those who act reckless when lifting, office workers who use unhealthy chair and people who heavily exercise are at risk. Lumbar hernia may be triggered by smoking, which is a risk factor for almost all diseases. On the other hand, sneezing strongly or simple bending motions (such as picking up something off the floor) may cause lumbar hernia, event without any risk factors present.

How does lumbar hernia manifest?

The most prominent symptom of lumbar hernia is low back and leg pain. The patient states “my low back radiates to leg” to describe the pain. However, it may manifest in the form of lumbar or leg pain alone. Numbness and tingling in leg are seen frequently in lumbar hernia. The condition progresses, if left untreated; resulting in strength loss in feet, urinary incontinence and serious symptoms such as paralysis.

How is lumbar hernia diagnosed?

Not every low back pain is caused by lumbar hernia. Other conditions may cause symptoms similar to lumbar hernia, such as mechanical low back pain, rheumatism and low back injuries due to exercising as well as tumor and cancer. Therefore, many aspects should be considered when diagnosing lumbar hernia. The best diagnostic modality is MRI scans. MRI scan demonstrates the disease and its location in the spine. Location and grade of lumbar hernia are detected and it is decided whether surgery will be carried out or not.

What is the treatment of herniated lumbar disc?

Medical treatment is preferred in the initial stages of the condition. Medical treatment plays an efficient role for many patients in elimination of pain and engagement in activities of daily life. Muscle relaxants and pain killers are taken into consideration thereafter. Physiotherapy may be combined with medical treatment. Surgery is planned if this treatment does not help complaints of patients.

How is lumbar hernia operated on?

The surgery is carried out by a neurosurgeon. The goal of lumbar hernia surgery is to remove the piece of cartilage that compresses the nerve. Microdiscectomy surgery (a microsurgical technique) is the most recent surgical treatment option for lumbar hernia. The surgery is performed by an experienced surgeon and it lasts for approximately 30 minutes. The herniated part is accessed through a small incision under scopic imaging guidance; the hernia is removed under surgical microscope without any damage to vertebrae. The patient is mobilized on the same day and discharged to home the next day. Success rate of the technique is over 90% thanks to correct diagnosis and timing.

It should be remembered that lumbar hernia is a treatable spinal disease. The patients with abovementioned symptoms or suspicion of the condition should present to a neurosurgeon.

Prof. Hasan MİRZAİ, M.D.