Lumbar Disc Prolapse (Herniation / Bulging)

Spine Conditions

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A disc prolapse (or herniation/bulge) is a rupture or bulge of an intervertebral disc. It usually occurs when the soft, jelly-like centre (nucleus pulposus) of the disc escapes from its usual position and bulges into the spinal canal. This bulge can put pressure on spinal nerves or spinal cord. Material from the herniated disc can cause an inflammatory reaction as well which can further contribute to nerve irritation. Compression and/or irritation of the spinal nerves are usually the cause of your symptoms.

An intervertebral disc can rupture or bulge suddenly as a result of excessive pressure, bending or heaving lifting using inappropriate body mechanics. Interverbal discs can also rupture or bulge with the application of a smaller amount of force usually in the context of the ageing process (‘wear and tear’) of the spine.
Signs & symptoms What tests are needed? How is it diagnosed? When surgery will be considered Surgical treatment

Signs & symptoms

In most cases symptoms will resolve spontaneously over about six weeks, although this depends on the size of the disc prolapse seen and surgery may be needed earlier. Signs and symptoms that patients experience include:

  • Shooting pain that travels down the leg (radicular pain/sciatica). This is usually from compression of the spinal nerve that travels down to the leg.
  • Low back pain that can be quite generic in nature or focused at a particular spot. LBP can be accompanied with radicular pain/sciatica.
  • Cramps or spasms.
  • Sensation changes such as numbness or pins and needles (paraesthesia) in the bottom of the leg or foot.
  • Weakness or motor deficit. This does not always occur but if it does it means that a spinal nerve is very compressed.
  • Loss of spinal reflexes.
  • Loss of power in the legs/feet with numbness associated with a change in control of the bowel or bladder. This is an emergency and you must go to a hospital immediately.

What tests are needed?

Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) will be performed when planning surgery to help confirm diagnosis, reveal the anatomy of the herniated disc, assess nerve root compression and identify the precise location of the effected disc level.

How is it diagnosed?

Diagnosis is made from the findings of the clinical examination, your symptoms and relevant tests.

When surgery will be considered

  • Cauda equina syndrome. A large disc prolapse can stop the function in lumbar spinal nerves. This produces cauda equina syndrome which results in numbness around the bottom, low of power in the legs and loss of bowel and bladder function.
  • Surgery will be considered as the last resort when you have ongoing symptoms despite non-surgical treatment.
  • Significant radicular pain (or sciatica)- shooting pain that travels down the leg and/or buttock pain.
  • Weakness or motor deficit in the leg/s.
  • Sensation changes such as numbness or pins and needles (paraesthesia) in the leg/s.

Surgical treatment

The aim of surgery for lumbar disc prolapse is to relieve compression and/or irritation of the affected spinal nerve to improve your symptoms. Mr Gomes performs a number of surgeries for lumbar disc prolapse. This will be assessed and discussed at your consultation in order to choose which option is right for you.

  • Lumbar Microdiscectomy – removal of part of the disc compressing and putting pressure on the spinal nerves.

  • Lumbar Laminectomy and Microdiscectomy – removal of the bony roof surrounding the spinal canal to create more space for nerves while also performing a microdiscectomy

  • Lumbar Fusion – permanently connects two or more vertebrae in your spine. It is usually needed if there is severe disc degeneration associated with loss of height and/or subluxation (slippage between the vertebrae.)

Spinal injections

Spinal injections may be used for the investigation and treatment for lower back pain with radicular symptoms. They are used to alleviate pain and can help identify the specific pain generators. These can be ordered by either the GP, in consultation with a pain physician or Mr Gomes depending on the complexity of the symptoms, signs and imaging findings.

The common forms of spinal injections include:

  • CT Guided Nerve Root Injections
  • Epidural steroid injections
  • Facet joint injections

Local anaesthetics and/or steroid is injected thought the skin at the back under CT guidance. Patients may obtain a significant benefit and surgery can sometimes be delayed or avoided all together.

Surgical treatment

Only a very small number of patients with lower back pain with radicular symptoms require surgical intervention. This will be assessed and discussed at your consultation with Mr Gomes.

Mr Gomes performs a number of surgical procedures which will be recommended taking into account the underlying condition and individual patient factors. Specific procedures are dependent on which part of the spine is affected. Refer to the specific spinal region for further detail.

For all appointments and enquiries, please phone   03 8318 4929

MAIN CONSULTING ROOMS

Mayfair Specialist Centre
Level 7
250 Victoria Parade
East Melbourne VIC 3002

ALSO CONSULTING AT

Knox Private Hospital
Suite 1A
262 Mountain Highway
Wantirna VIC 3151

Holmesglen Private Hospital
Suite A1
Paso Consulting Suites
490 South Road
Moorabbin VIC 3189

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