Lumbar disc herniation it has an acute (sudden) onset, often without a detectable trigger factor. Except in cases of major neurological deficiency, which constitutes an emergency, it is recommended to treat using drugs for 6 weeks or longer after the onset symptoms. If no improvement occurs after 6 weeks, surgical treatment may be recommended.
Root pain associated with lumbar disc (nucleus pulposus) hernia can be severe. For most patients, pain control occurs approximately 4 weeks after the onset of symptoms, and normal activities can be resumed.
Lumbar disc herniation is a common spinal disorder, which occurs in approx. 95% of cases at L4-L5 or L5-S1 level. The peak incidence occurs between 30 and 55 years. In most cases, the discs herniates in the posterior side (back and side?), compressing the nerve root on the same side when exiting the dural bag. Thus, for example, a disc herniation L5-S1 compresses the nerve root S1.
Radiculopathy manifests through pain, paresthesia (tingling) or both in the distribution of the affected nerve root. In this case, it is caused by irritation of the nerve root by the herniated disc. Each nerve root has a specific range of sensory and motor distribution. Root pain is frequently described as having a stinging or stinging character. Also, tingling or numbness may occur in the same distribution area. Sciatica is a root pain in the L5 or S1 root territory. Patients usually describe a deep pain in the buttock and posterior and postero-lateral thighs that can lower below the knees, at the level of the leg and the side of the foot. A patient with a disc herniation L4-L5 may describe a burning pain that descends from the groin on the lateral side of the thigh and leg and continuing at the level of the dorsal (upper) leg to the thumb. The pain is often aggravated by coughing, sneezing or tightening. It can also be exacerbated by certain positions, such as sitting or standing. . In general, pain is alleviated by rest.
Although most patients recover without surgery, patients with large herniated discs in the lumbar midline may have significant neurological deficits. Horse tail syndrome it is caused by any bulky mass located in the spinal canal, at the level of the horse’s tail.
The ponytail consists of the lumbar and sacral nerve roots that start from the lower portion of the spinal cord. These fill the lower dural bag of the L2 vertebra. Symptoms consist of urinary retention or incontinence (loss of sphincter control), anal incontinence, anesthesia in the saddle (abolition of sensitivity in the inguinal area), progressive weakness of the lower limb or leg, often bilateral. Although horse tail syndrome is rare, neurological damage is severe and represents a surgical emergency. It is important to note that not all lumbar disc herniation on the midline causes horse tail syndrome. As with other types of disc herniation, the patient with disc herniation on the midline may be asymptomatic (with no symptoms), may present only back pain, or may have unilateral or bilateral radiculopathy (impairment of a nerve root on one side or on both sides), without muscular weakness or sphincter dysfunction. These cases do not represent surgical emergencies.
The primary treatment for radicular pain should be the conservative one, the education and the peace of mind of the patient, so that the patient can recover without the help of surgery. The most common non-surgical approaches are (short-term) rest, back muscle exercises, kinetotherapy, NSAIDs (non-steroidal anti-inflammatory drugs), muscle relaxants, opioid analgesics (analgesics) and epidural corticosteroid infiltration.
Surgical indications: The clinical examination must be correlated with the radiological study (the elements found in the clinical examination must be consistent with the MRI anomaly). The symptoms should have persisted for at least 6 weeks without improvement after conservative treatment.
Surgical options: lumbar microdiscectomy under general or regional anesthesia is the most effective surgical treatment for uncomplicated lumbar disc herniation.