Lumbar Herniated Disc

Discs are normally soft and cushion the spine during stress. The discs are “intervertebral discs” meaning they are typically contained in between the vertebral bodies (bones of the spine).  A herniated disc referes to a disc that is no longer contained completely between the intervertebral space.

Causes

As discs lose water content with aging, they actually become less susceptible to herniation.  Disc herniations occur when the intradiscal pressure, which is influenced heavily by mechanics and position, exceeds the annulus’s ability to contain the disc.  The annulus is a ligamentous-like structure that surrounds the disc.  Herniations can be classied further as protrusions or extrusions depending on the size of the herniation.

Symptoms

Symptoms include back pain, possibly with radiation into the lower extremities depending on the type of disc injury/degeneration.  Symptoms frequently overlap with  stenosis or cervical degenerative disc disease.

Treatment

Procedural treatment for disc herniations can include cortisone injections under imaging guidance via a transforaminal or interlaminar approach.  The location of the injection is decided by the distribution of symptoms and imaging findings.  Regenerative injections including platelet-rich plasma (PRP) injections are also being used experimentally to provide a healthier environment to promote healing in the region.  Some physicians will inject material into the disc itself.

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