What is lumbar disc disease ?
Lumbar disc disease is a musculoskeletal disease exhibiting symptoms of lower back ache. Lumbar disc disease occurs due to the degenerative disorders that can lead to low back pain, often known as lumbar spondylosis. It is a very common problem in the aging population. In most of the cases, low back pain is self-limiting and resolves itself within 5 to6 weeks, without any medications.
In most cases of low back pain, no treatment is usually needed. It is important to first find out any serious underlying causes of low back pain that need further evaluation by a doctor.
Signs and symptoms of the disease :
- Unmanageable back pain pain
- Family history of cancers
- Use of intravenous drugs
- If pain increases during sleep
- Apart from these serious conditions there are many other causes of low back pain.
There are three main reasons that contribute to lumbar disc disease :
- Internal disc disruption
- Degenerative disc disease
- Segmental instability
Causes of lumbar disc disease :
The lumbar spine is composed of motion or motor segments. Each motion segment consists of two vertebral bodies. The invertebral disc acts as the cushion of the spine. The invertebral disc is made up of mostly water or fluid content allowing it to maintain cushion like properties of the spine. As people age the invertebral disc loses some of its water content due to wear and tear. As this happens the outer layers of the disc are more likely to develop fissures, which can be a significant cause of low back pain. This is the first stage of the internal disc disruption. When the outer layer of the disc loses its normal content of water level then reduces its ability to act as a cushion to the spine. This condition leads to degenerative changes in the vertebral bodies of the spine. When this occurs the condition is known as a degenerative disease which progress with age.
These degenerative changes lead to the destruction of the ligamentous and other soft tissue of the spine. This is known as segmental instability. This is the final stage of lumbar disc disease.
Patients with lumbar disc disease face severe low back pain. Pain increases when one is sitting, bending etc. This pain may persist for over 6 to 8 weeks.
Risk factors :
Lifting heavy loads, stressing the torso, motor vehicle driving are the identified to be risk factors.
Time to seek medical treatment :
Commonly elder people complain of low back pain. These conditions may not need any of medical care or treatment. It resolves without any treatment. In the case of younger generation, these symptoms should be evaluated by a doctor.
If pain does not subside with medicines then surgical treatment may be opted for.
Surgical treatments include lumbar decompression, lumbar fusion, and lumbar disc replacement.
Diagnosis of the disease :
Diagnosis of this lumbar disc disease begins with a physical examination of the body. The doctor examines the back for flexibility, the range of motion, and changes in your back. Diagnosis includes plain x-ray films, CT scans or MRI of the lumbar spine. These imaging studies give the complete picture. ENMGs (Electromyogram) assess the nerve conduction helping the doctor to base his treatment.
Treatment for the lumbar disc disease :
Most of the cases low back pain can be managed when you to take a short period of rest. Pain relievers can help with pain.
If symptoms do not resolve by medication then patients should go to the doctor for consultation.
Medical treatment :
Initial treatment of lumbar disc disease consists of anti-inflammatory medications including ibuprofen or naproxen. These medications can help relieve both pain and inflammation associated with the lumbar disease. Muscle relaxants, such as cyclobenzaprine can provide short term relief. These medications must be used as and when required only. Physiotherapy has an important role at this stage.
Surgery :
Surgery is an option for the treatment of lumbar disc disease in people who do not respond to the medications. Surgical treatment includes lumbar decompression, lumbar fusion, and lumbar disc replacement.
In lumbar decompression process surgeons remove a small portion of the bone from the back of the spinal cord column to widen the space available for the nerves coming out of the spinal cord. This can relieve the pressure on the spinal nerves.
In lumbar fusion, many types of options can be sought. In most of the cases, the surgeon removes most of the invertebral disc and replaces it with either bone or any other material. In many cases of lumbar disc disease, the disc is a major source of pain. Once it is removed the pain automatically subsides.
In disc replacement technique removing the invertebral disc and replacing it with a bone or an artificial disc is insertion is done. The advantage of this technique is patient recovers fast and leads their normal life easily.
After surgery :
Most of the cases low back pain resolves spontaneously after few weeks from the day of surgery.
Prevention of the disease :
In many cases of lumbar disc disease cannot be prevented because it results from a combination of normal degenerative changes that occur with aging and some genetic problems. But in some cases, the best method to prevent lumbar disc disease is to maintain muscle strength. Using simple and proper lifting mechanics and not lifting heavy objects using the lower back muscle.
No undue pressure should be placed on the back. Most of the cases patient with low back pain does not require surgery. In fact, more than 95% find symptomatic relief through nonsurgical therapies, such as exercise, medication, and physical therapy.
Outcome of the treatment for patients :
The outcome of the treatment varies from patient to patient with lumbar disc disease. Some may recover fast or may take time depending on the factors such as age, nature of work etc. Many patients have reported quicker recovery with the advancement of treatment options in surgical and nonsurgical procedures. We at KIMS evaluate the patient and advice the best possible options.