Frequently Asked Questions About Lumbar Herniated Disc

The prevalence of lumbar hernia in society is as high as one in ten. Lumbar hernia is most commonly seen between the ages of 35 and 50 and occurs equally in both sexes. People who work նստած and do so on an unsuitable chair are more likely to develop lumbar hernia. Those who have to lift heavy loads, act carelessly while doing sports, start exercising without warming up, or have posture and sitting disorders are at risk. Smoking and alcohol use, which are considered risk factors in almost every disease, may also trigger lumbar hernia. People who live a stressful and restless life are also likely to develop lumbar hernia. The more you are exposed to these risks, the greater your likelihood of having a lumbar hernia. In addition to these factors, hereditary (familial) factors should not be forgotten. Those with a family history of lumbar hernia are at risk.

Many patients hesitate about why they are having surgery on their lower back even though the pain is in their leg. The sciatic nerve is the thickest nerve in the human body. Fibers coming from the L4, L5, S1, and S2 roots contribute to its structure. The sciatic nerve contains motor fibers that provide movement and strength in the leg, as well as sensory fibers that provide sensation. As a result of compression in any of these roots, sensations such as pain and numbness are carried to the area related to the sensory fibers, so the patient feels the pain in the area where the nerve spreads. Because the pain in lumbar hernia follows the sciatic nerve, the term sciatica used among the public is considered synonymous with lumbar hernia.

Discs located between two vertebrae are elastic structures with a thickness of 4–6 mm. They consist of two different structures: the central nucleus pulposus and the ring-shaped annulus fibrosus surrounding it. With these features, they function as cushions/shock absorbers between the vertebrae. Discs are located between the vertebrae throughout the spine, allowing the vertebrae to move more easily over one another and thereby providing limited mobility of the spine. They also help distribute the weight placed on the spine over a wider surface area.

Discs in the lumbar region are exposed to more weight than discs in higher regions, such as the neck. This is one of the reasons why herniation occurs more frequently in the lumbar region.

As a result of degenerative changes, the nucleus pulposus loses its water content and elasticity, and when the surrounding annulus fibrosus also loses its strength, a strain or an improper movement may cause a bulge toward the spinal canal, as seen in the image. This condition is called protrusion. Bulging is a milder form of protrusion in which the disc extends diffusely beyond the edges of the vertebra.

Sometimes this degenerated disc, at a more advanced stage, pierces the posterior longitudinal ligament and extends into the canal; this is called an extruded disc. If a piece of the extruded disc falls into the spinal canal, it is called a free (sequestered) fragment.

In cauda equina syndrome, disc material (nucleus pulposus) enters the spinal canal and compresses the nerve fibers exiting the spinal cord. As a result of this compression, a very severe condition may occur, characterized by saddle-like sensory loss (numbness), weakness in the legs that may progress to paraplegia (paralysis of both legs), urinary and fecal incontinence, and loss of sexual function. In cauda equina syndrome, the patient may or may not have had previous complaints of lower back pain and sciatica. The syndrome involves suddenly developing severe neurological findings, and if emergency intervention is not performed, the likelihood of the patient becoming paraplegic is high. In delayed intervention, the chance of recovery from developed findings such as leg paralysis and loss of bladder-bowel control is low. In patients who develop foot drop, the patient cannot lift the foot upward from the ankle and walks by dragging it. Lumbar hernias that cause cauda equina syndrome and foot drop require emergency surgery.

In L3-4 discs: The compressed root is the L4 root, and pain or sensory loss is felt on the front of the thigh and the inner side of the leg. In L4-5 discs: The compressed root is the L5 root. Pain is felt in the hip, the outer side of the leg, the dorsum of the foot, and the big toe; numbness may be felt on the outer side of the leg and in the big toe. Weakness may develop in lifting the big toe and the foot upward. In L5-S1 discs: Pain may occur in the hip, the back of the thigh and leg, the heel, and the outer lower part of the foot; sensory loss may appear on the back-lateral side of the leg and the outer side of the foot. A decrease or loss of strength in pushing the foot downward may develop.

Lumbar hernia most commonly occurs at the L4-5 and L5-S1 levels. Accordingly, the L5 or S1 roots come under pressure. Since both roots form the sciatic nerve, pain occurs in the area corresponding to the compressed root on the side where the herniation is present. Along with nerve root compression, the muscles located next to the spine in the back contract reflexively and go into spasm. Although this is actually a protective mechanism of the body, the spasm causes pain in the lower back that increases with movement. Scoliosis may even develop in the spine due to muscle spasm. (Antalgic posture)