Lumbar Disc Disease FAQ’s

The pinched nerves are usually caused due to inflammation of the nerve roots near the spinal cord where they exit. The inflammation, once improved, causes relief in the pinched nerve. This improvement in inflammation can be caused rest, anti-inflammatory medication, steroid medications or cortisone shot. Occasionally the cause of inflammation may be persistent compression over the nerve, which may not get better with all form of conservative management.

For patients undergoing fusion surgery, it is highly desirable that they quit smoking. Smoking is detrimental for bone healing and hence the fusion. Smokers are at a higher risk of nonunion, that means non-healing of the fusion mass, and these patients may need revision surgery. If the patient is not able to quit smoking, it is at least highly desirable for them to quit for three months. Use of the nicotine patch in place of smoking has the same detrimental effect as smoking itself.

Patients are not required to start their physical therapy till two weeks after the surgery. After two weeks of surgery, physician reexamination will help in deciding if the patient requires physical therapy or not. Many of the patients do not require physical therapy after the surgery.

Smoking has proven to cause spine problems, including neck and lower back. At the same time, smoking is detrimental for patients who require spine surgery, especially fusion surgeries. It has been shown that smoking delays spine fusion, as well as lead to higher incidence of nonunion and possible need for revision surgeries.

Most of the patients with cervical disk disease and subsequent pain can be treated with conservative means and do not require MRI. Patients who fail conservative measures, as well as patients who develop worsening neurological deficit or weakness or involvement of bowel or bladder or gait may require MRI. Patients usually need to see a physician before an MRI can be done.

Weight loss can be very helpful in treating, as well as preventing back surgery apart from its benefit in many more diseases. Patients with higher weight have increased load on their lumbar spine and may have persistent pain, delayed healing, or failure of healing after spine surgery.

Most common causes of back pain are disc disease or muscles. There can be other causes of pain including arising from the bone or from the covering of the nerves or from the injury to the ligaments. Occasional cause of back pain can be from kidney or prostate in males or uterus and ovaries in females. Rarely, a patient may have back pain because of involvement of other organs in their abdomen like the pancreas or the liver.

Low back pain is one of the most common diseases known to mankind. They may affect up to 60 to 80% of human beings. Most of the patients with low back pain have pain free period, which may last from months to years. Some patients have a higher incidence of recurrence of low back pain. These patients may need medical attention to get relief of low back pain. Most of the time, low back pain can be treated without surgical intervention and with conventional means.

Common complications of a low back spine surgery are bleeding, infection, leak of cerebral spinal fluid temporary or permanent neurological deficits, blindness, worsening of pain, failure of fusion, failure of implants. There may be risks due to the anesthesia also.

People with bad posture or work that involves bad biomechanics of the low back, or patients with systemic disease, overweight, smokers, other chronic problems are at high incidence of developing low back pain.

Bedrest can help in back pain only if the back pain is of acute onset. Even in that case, the bedrest is only helpful for the first 48 hours. After that, patients who are more active and/or are involved in physical therapy have the best results from back pain. Prolonging bedrest is of no use for the treatment of back pain.

Spinal discs are discs of cartilage which are found between the vertebrae in our spinal column. They help movement as well as stabilize the spine. They have a central gelatinous core called nucleus pulposus and a peripheral cartilage called annulus fibrosus. A healthy disc is required for normal functioning of the spine.

If the patient has a superficial infection, few days of antibiotics will help heal these infections. Occasionally patient may develop deep infection. In these patients may need IV antibiotics for a longer period. If despite all efforts or in patients with rapid deterioration due to infection, surgery may be needed to help clean off the infection.

Most of the patients do not need surgery and can be treated with conservative means. When the patients do not respond to conservative measures, or if they have worsening neurological deficit, or worse pain, they may need surgery.

Most of the patients who have straightening of spine is due to muscle spasms. These patients are usually treated with medications, some rest, and physical therapy. Patients may take muscle relaxants to relieve the spasms. Patient may also take anti-inflammatory medication or pain medications to treat their pain. Physical therapy helps these patient in relieving the muscle spasm as well as recovering from the lumbar spine disease and getting back their mobility as well as strength in the muscles.

Most of the patients with degenerative disc disease causing low back pain are treated with conservative means including anti-inflammatory medications and physical therapy. Occasionally the patients may not respond to such therapy, or may have worsening symptoms, in which case they may need invasive measures in the form of injections or surgery.

Higher lumbar spine degenerative disc disease like L2, 3, or L3, 4 may cause thigh pain. Patients who have involvement of L4, 5, or L5, S1, which are the common discs to degenerate and cause problems, usually cause pain along the outer aspect of the leg, and below the knee.

Yoga is a very good exercise for patients who suffer from fibromyalgia as well as low back pain due to degenerative disc disease. Yoga not only helps stretching all the muscles, but also helps toning of the muscles, which contribute to pain relief.

Patients who have herniated disc with pain going down their legs in the form of sciatica usually gets pain relief within about six weeks. Patients with degenerative disc disease, which is usually caused by aging process, may get episodes of back pain interspersed, or months to years. If taken care of, the patients may have long duration of back pain free periods.

Non-surgical options for treatment of low back pain include medications in the form of anti-inflammatory medication or pain killers, physical therapy, exercises in the form of stretching and the strengthening of the muscles. There are other minimal invasive methods of treatment, which include cortisone shot along the nerve root, or in the spinal canal.

There are multiple alternative therapies deal with pain, which may include medications in the form of anti-inflammatory medication or pain killers, physical therapy, exercises in the form of stretching and the strengthening of the muscles. There are other minimal invasive methods of treatment, which include cortisone shot along the nerve root, or in the spinal canal.

Patients who develop neurological deficit in the form of weakness or involvement of bowel or bladder may have irreversible damage if the surgery is delayed enough.

When patient has back pain or has a surgery in which enough bone is removed to destabilize the spine, in these cases patient may need a fusion surgery to stabilize the spine, as well as to alleviate the symptoms.

General surgical risks of low back surgeries include bleeding, infection, persistence of pain, reversible/irreversible nerve damage leading to tingling, numbness, or weakness down the legs or involvement of bowel or bladder, failure of resolution of symptoms, failure of fusion, failure of implants. Most of the patients can undergo a safe surgery due to the development of vision magnification as well as refined surgical techniques. There are anesthesia risks also associated with this surgery.

Though these things depend on the type of surgery patient has undergone, patient can usually be progressively back to their normal activities, starting from three to five days from surgery. Patients are encouraged to take care of their activities of daily living, as well as light household activities. Patients can get back to driving once they are free from pain medication and are able to sit for a duration of period for driving, which may take upto 2-3 weeks or more.

The type of surgery depends on the presenting complaint, examination findings, as well as imaging findings in the form of x-ray and MRI. Some patients may need to undergo just discectomy, or laminectomy, while others may need a fusion surgery on their back to relieve their symptoms. To know more about the type of surgery, the patient needs to discuss this with their spine surgeons.

Spine surgeries like discectomy and laminectomy usually last about one to one and a half hours. Spine fusion surgeries, may take longer periods, up to two and a half to four hours or more. It depends on type of surgery, and as well as the level of spine to be operated upon.

There are multiple reasons for a disc to cause pain if it is injured. The pain may be just because of injury to the disc itself or rupture of the ligaments through which it passes into the spinal canal. It may also cause pain because of pressure on the nerve roots that are pushed by the disc in the vicinity.

Bulging disc is when the disc pushes the ligament pushing into it into the spinal canal while herniated disc is when the disc itself gets out of the ligament and comes to lie into the spinal canal. Bulging disc may be normal and may not cause pain. Herniated disc also does not cause pain in all patients but they may cause compression on the nerve roots and cause radiating pain going down the legs or, in severe cases, may cause weakness associated with tingling, numbness, involvement of bowel or bladder.

Bulging discs, especially in the lower spine, may be normal findings in an adult. They rarely cause problem by causing pressure on the nerve roots.

Herniation of disc may be caused by multiple factors. If the disc is diseased due to age, other chronic diseases, smoking, etc., then they are more prone to injury. Any sudden movement or lifting or moving, heavy weights, can cause enough pressure in the disc to cause rupture and herniate.

Herniated disc can present either present with back pain or radiculopathy in the form of pain going down either lower extremity or either leg. It may or may not be associated with tingling or numbness. In severe cases, there may be weakness of specific group of muscles in the leg or involvement of bowel or bladder.

Not all bulging discs or herniated discs are painful. But bulging discs in most cases are not painful and are asymptomatic. Herniated disc have a higher chance of causing symptoms in the form of pain going down either lower extremity or either leg. It may or may not be associated with tingling or numbness. In severe cases, there may be weakness of specific group of muscles in the leg or involvement of bowel or bladder.

Degeneration means gradual damage of the tissue. Degenerative disc disease represents aging of the disc, either appropriate to the normal age of the patient, or maybe accelerated due to injury or chronic disease, or other factors like smoking, obesity.

Lumbar instability means that the spine is not stable and there is excessive abnormal movement between two vertebrae. This is usually diagnosed by imaging in the form of X-rays, CT scan, or MRI of the patients. Instability may lead to compression of nerve roots causing radiculopathy with or without back pain.

Spinal stenosis means narrowing of the spinal canal. It is can be at the cervical or thoracic or lumbar level. Most common spinal stenosis is at lumbar level and it, when narrowed, can compress nerves, causing pain going down the legs, with or without tingling, numbness, weakness, or involvement of bowel or bladder.

Sciatica is another name for lumbar radiculopathy, in which patient has pain going down their legs. The pattern of pain depends on the nerve root involved, but the most common is pain going down the outer side of the thigh and leg into the foot.

The diagnosis of Lumbar disc disease is made by history and examination of the patient. The confirmation of diagnosis is done by imaging in the form of X-rays and MRI. Occasionally the patient is having contraindication to MRI, patient may need to undergo a CT scan. When a CT scan is done, occasionally the patient may need to get injected with a dye before the CT scan and this is called CT myelography. Occasionally patient may need a CT scan along with MRI also.

Most of the patients get treated with conservative means. In case the patient is not getting relief despite continuous conservative measures, or if there is worsening of pain associated with or without weakness or involvement of bowel or bladder, the patient may need surgical intervention in the form of surgery.

Some patients are good candidates for minimally-invasive spine surgery and they can get better with that. History, physical examination, as well as special investigations like X-ray and MRI, are needed in order to discuss regarding options of minimal invasive spine surgery. Some patients are not good candidates for minimal invasive spine surgery and doing such a surgery in such patients may lead to non-resolved solution of the symptoms or worsening.

Warning symptoms of lumbar disc disease include worsening pain, tingling and numbness, development of weakness, or worsening of weakness, involvement of bowel or bladder in the form of incontinence of urine or stools, presence of fever, unintentional weight loss. In such conditions patients should immediately seek medical attention.

Spinal injections help in relief of pain. Many times, they may be the only procedure required for patients to get long term relief from pain. If patients are not relieved by 1 or multiple spine injections, they may have to undergo surgical procedure to get their pain relief.

Spinal disc problems can present in the form of back or neck pain or, radiculopathy in the form of limb pain, with or without tingling or numbness going down either lower extremity. Rarely they may have weakness of involvement of bowel or bladder.

Red flags in back pain are history of cancer, immunosuppression due to medications or disease, prolonged steroid usage, IV drug usage, trauma, fever, unintentional and unexplained weight loss. These patients should a physician as soon as possible.

General blood workup is needed in most patients before the surgery. This will include blood counts as well as metabolic profile. Special tests may be needed in some patients if the physician has suspicion of some other disease. Most of the patients will have to undergo X-ray and MRI, or a CT scan before the surgery to confirm their diagnosis.
What are the possible surgical complications from a low back surgery?

Common complications of a low back spine surgery are bleeding, infection, leak of cerebral spinal fluid temporary or permanent neurological deficits, blindness, worsening of pain, failure of fusion, failure of implants. There may be risks due to the anesthesia also.

Patients should try conservative measures including physical therapy before they are undergo surgical treatment for their disc problems. Patients who have neurological deterioration with involvement of muscle power or bowel or bladder involvement may need immediate surgery and are not considered for trial with physical therapy.

If the lumbar disk disease is left to itself, it may be progressively worsening. The patients may also have recurring episodes of pain if they are not managed properly. With every recurrence, the chances of severity as well as having similar or worse episodes is higher.

Many patients who have one or a few episodes of back pain with or without neuropathy may be better for a long time. Occasionally, the patients may have recurring episodes and may need intervention for that.

The pain can be treated by yourself using Tylenol, Aleve, Advil in prescription-strength doses or over-the-counter doses. If the pain is not relieved despite taking these medications and use of rest, ice, heat then you should see a doctor.

If you have tried medications like Tylenol, Aleve, Advil, using ice, heat and this had not benefited you, you can see your primary care for further management options. If you start having radiating pain down the arm or leg, which is associated with tingling and numbness, with or without night-time discomfort then you may need to see a spine surgeon for that. If you develop weakness in either extremity, imbalance, involvement of bowel or bladder in the form of retention or incontinence or decreased sensation around the genital areas or either extremity, you should seek urgent help by seeing a doctor possibly in an emergency setting.

Physical therapy helps in most of the patients. It helps not only keep your functions in an optimum state but also helps recover from pain. Physical therapy should be done under supervised clinicians. The physical therapists can also let you know regarding some home exercises programs which will help take care of pain on the long term.

Spine surgeons have been doing cervical and lumbar disc arthroplasty of disc replacement for many years now with very good results. Spine surgeons have also been doing minimally invasive discectomies in which case fusion may not be needed and the patient may begin its mobile segment. Some patients may be a candidate for a procedure called laminoplasty which is done from the back of the neck and in which fusion is not required. In patients of lumbar stenosis, an implant can be inserted in the back without disturbing the anatomy of the spine to increase the space for nerve roots. There are many more surgeries which are being tried on a research basis and not yet to be validated.

Degenerative disc disease is a process of aging of the disc. The disc gradually loses its water content and becomes stiffer henceforth causing loss of flexibility and motion within the vertebra. This usually happens as a part of aging process, but it can be accelerated due to certain other conditions like chronic diseases, smoking, injury, overuse, trauma etc.

Worsening tingling, numbness or weakness or feeling of electric shocks going down the arms or legs are serious symptoms of cervical or thoracic disc disease. These patients should be seen by a spine surgeon as soon as possible and there may be a chance that they will need surgery to be relieved from these symptoms. If these patients are not taken care of they may develop neurological deficit which may or may not be irreversible.