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- One common stretch to test for a herniated disc is the straight leg raise, or LaSegue, test. For this test, the patient lies down flat on the back and the doctor gently raises the affected leg until pain is felt. If pain occurs when the leg is raised at a 30- to 70-degree angle, it is considered a sign of lumbar disc herniation.
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The vertebral column, or backbone, is made up of 33 vertebrae that are separated by spongy disks. The spine is divided into 4 areas:
- Cervical spine: The first 7 vertebrae, located in the neck
- Thoracic spine: The next 12 vertebrae, located in the chest area
- Lumbar spine: The next 5 vertebrae, located in the lower back
- Sacral spine: The lowest 5 vertebrae, located below the waist, also includes the 4 vertebrae that make up the tailbone (coccyx)
The lumbar spine consists of 5 bony segments in the lower back area, which is where lumbar disk disease occurs.
- Bulging disk. With age, the intervertebral disk may lose fluid and become dried out. As this happens, the spongy disk (which is located between the bony parts of the spine and acts as a “shock absorber”) becomes compressed. This may lead to the breakdown of the tough outer ring. This lets the nucleus, or the inside of the ring, to bulge out. This is called a bulging disk.
- Ruptured or herniated disk. As the disk continues to break down, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or herniated, disk. The fragments of disc material can then press on the nerve roots located just behind the disk space. This can cause pain, weakness, numbness, or changes in sensation.
Most disk herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra (the L4-5 and L5-S1 levels).
What causes lumbar disk disease?
Lumbar disk disease is caused by a change in the structure of the normal disk. Most of the time, disk disease happens as a result of aging and the normal break down that occurs within the disk. Sometimes, severe injury can cause a normal disk to herniate. Injury may also cause an already herniated disk to worsen.
What are the risks for lumbar disk disease?
Although age is the most common risk, physical inactivity can cause weak back and abdominal muscles, which may not support the spine properly. Back injuries also increase when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy lifting and twisting of the spine can also cause back injuries.
What are the symptoms of lumbar disk disease?
The symptoms of lumbar disk disease vary depending on where the disk has herniated, and what nerve root it is pushing on. These are the most common symptoms of lumbar disk disease:
- Intermittent or continuous back pain. This may be made worse by movement, coughing, sneezing, or standing for long periods of time
- Spasm of the back muscles
- Sciatica – pain that starts near the back or buttock and travels down the leg to the calf or into the foot
- Muscle weakness in the legs
- Numbness in the leg or foot
- Decreased reflexes at the knee or ankle
- Changes in bladder or bowel function
The symptoms of lumbar disc disease may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.
How is lumbar disk disease diagnosed?
In addition to a complete medical history and physical exam, you may have one or more of the following tests:
- X-ray. A test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Magnetic resonance imaging (MRI). A procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.
- Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
- Electromyography (EMG). A test that measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle.
How is lumbar disk disease treated?
Typically, conservative therapy is the first line of treatment to manage lumbar disk disease. This may include a mix of the following:
- Bed rest
- Education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)
- Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
- Weight control
- Use of a lumbosacral back support
- Medicine to control pain and relax muscles
If these measures fail, you may need surgery to remove the herniated disc. Surgery is done under general anesthesia. Your surgeon will make an incision in your lower back over the area where the disc is herniated. Some bone from the back of the spine may be removed to gain access to the disc. Your surgeon will remove the herniated part of the disc and any extra loose pieces from the disc space.
After surgery, you may be restricted from activity for several weeks while you heal to prevent another disc herniation. Your surgeon will discuss any restrictions with you.
What are the complications of lumbar disk disease?
Lumbar disk disease can cause back and leg pain that interferes with daily activities. It can lead to leg weakness or numbness and trouble with bowel and bladder control.
Can lumbar disk disease be prevented?
Maintaining a healthy weight, participating in regular exercise, and using good posture can lessen your risk for lumbar disk disease.
Living with lumbar disk disease
Conservative therapy requires patience; but sticking with your treatment plan can reduce back pain and minimize the chance of worsening pain or damage to the disk. Conservative measures and surgery can both take time to be effective.
When should I call my healthcare provider?
Call your healthcare provider if your pain increases or if you start having trouble with bowel or bladder control.
Key points about lumbar disk disease
- Lumbar disk disease may occur when a disc in the low back area of the spine bulges or herniates from between the bony area of the spine.
- Lumbar disk disease causes lower back pain and leg pain and weakness that is made worse by movement and activity.
- The first step in treatment is to reduce pain and reduce the risk of further injury to the spine.
- Surgery may be considered if the more conservative therapy fails.
Overview
What is degenerative disk disease?
Disk degeneration is a normal part of aging. It’s also known as degenerative disk disease (DDD).
The degeneration develops over time. It affects the rubber-like disks between vertebrae — the small bones that make up the spinal column (backbone).
The disks act like cushions between those bones. When the cushions wear away, the bones can start to rub together. This contact can cause pain and other problems, such as:
- Adult scoliosis, where the spine curves.
- Herniated disk, also called a bulged, slipped or ruptured disk.
- Spinal stenosis, when the spaces around your spine narrow.
- Spondylolisthesis, when vertebrae move in and out of place.
How common is intervertebral disk degeneration?
Almost everyone has some disk degeneration after age 40, even if they don’t develop symptoms. It can lead to back pain in about 5% of adults.
Are certain people more likely to get DDD?
Certain people have a higher chance of developing disk degeneration:
- People who are very overweight.
- People who experience trauma to the spine.
- Professional drivers (for example, taxi and truck drivers).
- Gymnasts.
- Smokers.
Symptoms and Causes
What causes DDD?
A healthy back contains a number of rubbery cushions called disks. Each disk sits between a set of vertebrae, the bones that stack up to make the spinal column. Together, the discs allow a person to bend, twist and move freely.
As we age, our disks begin to wear away, for several reasons:
- Activities or sports can cause small tears in the discs over the years.
- Discs dry out or get weak over time.
- Injury can cause discs to break down faster.
Because discs are primarily composed of collagen and have a relatively poor blood supply, they do not heal like other parts of the body.
What are the symptoms of DDD?
When disks wear down too much, the vertebrae rub together. The grinding of the bones can cause:
- Pain.
- Stiffness.
- Tingling or numbness.
- Trouble with movement.
- Weakness in the legs or foot drop (can’t raise the front part of one or both feet).
What does degenerative disk pain feel like?
Degenerative disk pain:
- Can happen in the neck or lower back.
- May extend into the arms and hands or into the butt and legs.
- Can be mild, moderate or severe.
- May start and stop.
- Can get worse after certain activities such as bending, twisting or lifting.
- Can get worse over time.
Diagnosis and Tests
How is DDD diagnosed?
If you have symptoms of disk degeneration, you should tell a healthcare provider. The healthcare provider will:
- Review your medical history with you.
- Examine your body to see where it hurts.
- Ask you to describe what makes the pain worse or better.
- Ask you to rate your pain on a scale of zero to 10.
What tests might I get?
The healthcare provider might order some tests to take pictures of the bones and disks in your spine. The tests may include:
- CT scan.
- MRI.
- Spine X-ray.
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Management and Treatment
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Treatment for DDD usually starts with medications to control pain. It also involves physical therapy, or rehabilitation.
Common medications used to treat DDD include:
- Acetaminophen.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or meloxicam.
- Gabapentin, a membrane-stabilizer.
- Steroid injections into the disk area.
Physical therapy is also helpful to treat DDD. It can include many different strategies:
- Adjustments to the way you move (for example, how you lift a box) to lessen pain and avoid injury.
- Aquatic exercises, since being in the water takes pressure off your muscles and joints.
- Corrections to your posture.
- Joint mobilization or manipulation, which moves your joints in different directions to improve range of motion.
- Plans for exercising at home.
- Soft tissue mobilization, which puts deep pressure on muscles to stretch them and reduce tension.
- Strengthening your core, the muscles supporting your back.
- Stretches for flexibility.
- Traction, or gentle pulling of the arms and legs, often using ropes and weights.
How long will I need to do physical therapy?
Most people with DDD have rehabilitation one to three times a week for several weeks or months. Your rehabilitation needs will depend on:
- The severity of your symptoms.
- Your goals.
- Your insurance coverage.
You’ll “graduate” from physical therapy when you have reached your goals. Still, your healthcare provider will want you to exercise at home and stay active.
Will I need surgery for disk degeneration?
If more conservative options don’t work, some people choose to have surgery for disk degeneration. Options may include:
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- Artificial disk replacement:Artificial disk replacement is also called total disk replacement. It involves surgery to remove the damaged disk (diskectomy). The surgeon then implants a manufactured device that looks and acts like a disk.
- Diskectomy and spinal fusion: A diskectomy surgically removes a damaged disk. Spinal fusion then joins vertebrae together for stability. To make the connection, the surgeon uses a bone graft. This piece of bone comes from elsewhere in your body or from a deceased donor. The graft fuses with your spine. The surgeon will also place screws, rods, hooks or plates into the bones of the spine. The hardware hold bones together so they fuse.
Prevention
How can I reduce my risk of disk degeneration?
Disk degeneration eventually happens to everyone. You can’t prevent it, but you can slow it down and take action to protect your vertebrae:
- Focus on good posture.
- Keep your core muscles strong.
- Maintain a healthy weight.
- Quit smoking.
- Stay active.
- Use good technique when you move, twist and lift to prevent injury.
Outlook / Prognosis
What is the outlook for people with DDD?
Without treatment, disk degeneration usually gets worse over time. But pain medications, physical therapy and sometimes surgery can reduce pain and improve movement.
Researchers continue to study DDD, particularly ways to delay and treat it.
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Living With
What can I do to help ease the symptoms of DDD?
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Several strategies can help you manage DDD pain:
- Do your physical therapy exercises at home exactly as you were shown.
- Keep your core muscles strong to support your back and neck.
- Take your pain medications as prescribed.
- Use good posture when sitting and standing.
- Use heat and cold on the area that hurts.
A note from Cleveland Clinic
Disk degeneration is a natural part of aging once you turn 40. Still, if you develop pain in your neck or back that does not respond to over-the-counter pain medications, talk to a healthcare provider. Medications and therapy can control the symptoms of disk degeneration and help you stay active.