Lumbar Disc Problems

The lumbar region of the human spine is a location that is very susceptible to injury and trauma. A majority of the population experience back pain at some time during their life, and although in most cases the pain subsides after a time of rest, there is an enormous need for treatment of this malady. The various types of treatment for lumbar disc herniations include a more conservative method of rest, physical therapy, and anti-inflammatory or non-steroidal drugs. A more extreme condition would require surgery to try to alleviate the symptoms. The older, more traditional surgery is a posterior laminotomy, however, newer less invasive microscopic and endoscopic surgeries been implemented to increase success and recovery time as well. Although most of these operations are performed on the posterior, anterior surgeries are also performed, depending upon the nature of the injury. While these surgeries partially remove disc material affecting the spinal cord, another type of surgery is used to remove the disc entirely and replace it with prosthetics. Still, there are alternative treatments including chiropractic care, acupuncture, and physical therapy that are increasing in popularity. Due to the sensitivity and vulnerability of the spinal cord, the diagnosis and treatments have a moderate risk of failure, and force a patient to explore numerous options to relieve pain.
The vertebral column is composed of seven cervical, twelve thoracic, five lumbar, five sacral, and four coccygeal vertebrae. The lumbar vertebrae are numbered from one through five starting with the highest vertebrae, and preceded by the letter L. (i.e. the lowest vertebral body will be represented as L-5) Between the vertebrae of the cervical, thoracic, and lumbar regions are invertebral discs that serve as shock absorbers that allow the everyday movements of the spine. Discs themselves are represented by naming both of their adjacent vertebral bodies (i.e. a lumbar disc is can be identified as L-4 L-5 or L-4,5). The discs are made up of an outer ring of more dense material called the annulus fibrosus. The annulus fibrosus helps to contain the inner gelatinous material called the nucleus pulposes. Upon a stressful movement of the spine, the nucleus pulposes may rupture through the annulus fibrosus posteriorly toward the spinal cord. Pressure upon the spinal cord, which is the origin of nerves throughout the body, can irritate the nerves exiting through lateral spaces between adjacent vertebrae called the invertebral foramen. These nerves travel to the lower extremities cause a dull ache and sometimes numbness or loss of strength. The nerve most commonly affected by a disc herniation is the sciatic nerve. The sciatic nerve originates between the third sacral(S-3), and fourth lumbar(L-5) vertebrae, is formed in the pelvis and exits through the greater sciatic foramen towards the gluteal region. It then travels laterally underneath the piriformis muscle towards the pudendal nerve, then divides travels anteriorly down the leg until it divides near the knee into the politeal and tibial nerves(Shanahan, 1997).
A term herniated disc is used synonymously with ruptured or prolapsed discs. They describe a protrusion of the nucleous propulsus through the annulus fibrosus upon the spinal cord. Commonly herd terms such as a slipped or a bulging disc refer to the disc being close to herniation, but still remaining intact. In this case, the nucleus propulsus is contained, however, the contortion can still lead to decreased foraminal space, and sciatic nerve irritation. The symptoms for bulging or slipped discs are similar to those for a herniated disc, but are usually milder and less intense, thus requiring more conservative treatments(Shanahan, 1997).
An estimated eighty percent of the population suffers at least one episode of back pain in their life, and in as many as fifty percent of the cases, the problem will recur within the next three years (DiNubile, 1997). The purpose of this paper is to discuss lumbar disc problems that afflict a large portion of the population, and discern between the numerous treatment options available to a patient. It will discuss the wide range of these interventions and attempt to provide a clear view of the success and appropriate applications of the treatments.
The cause of a disc rupture can be traced to many events such as a single squat exercise by weight lifter, or the repetitive stressful jumping of a basketball player, or even