Charlottesville Pain Management Center - Interventional Pain Specialist, Musculoskeletal and Sports Medicine

Herniated Lumbar Disc

The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs.  These discs act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged many terms are used for this condition including disc rupture, disc protrusion, disc extrusion, slipped disc and herniated disc. All terms describe the same basic process. The disc has two primary components. Outer rings of tough connective tissue called the annulus and a soft central core of jell-like substance called the nucleus. A tear or weakness of the annulus can allow some of the central nucleus to protrude or herniated through the annulus. The herniated portion of the disc can cause pressure or impingement of the nerve at that level causing both back and leg pain. The leg pain is caused by a pinching of the nerve at the level of the disc. Some people only have leg pain associated with a disc herniation

A herniated disc is often caused by injury such as lifting a heavy object or an accident. However “spontaneous” disc herniations are also common. It is thought that this occurs as the result of “wear and tear” from daily activity and small injuries. One factor that can result in a pinched nerve is the mechanical effects of the ruptured disc. In other words, the tissue of the disc directly pinches the nerve.  Another effect of the ruptured disc is inflammation and swelling. The annulus tissue is a very irritating material. The annulus is referred to as an immunological sequestered tissue. This means that due to the characteristics and location of the annulus, the immune system does not recognize this tissue as self. This is important because this results in significant inflammation when the disc ruptures. The inflammation causes swelling and more pain. Since the nerve is directly next to the disc the nerve root also becomes inflamed and swollen. These two factors result in a pinched nerve causing pain in the back and leg.

Herniated discs often heal with time. This is a slow process and can often take up to a year. Large disc herniations causing pinching of multiple nerves or that result in severe weakness of the legs, loss of control of bladder / bowel function or uncontrollable pain may require surgery. The majority of people with herniated discs do not require surgery. More conservative treatments are often very successful in reliving the pain of the herniated disc and allow time for the natural healing process to occur.