Lumbar Disk Disease (Herniated Disk)
What is lumbar disk disease?
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, including 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, 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 disk material can then press on the nerve roots
located just behind the disk space. This can cause pain, weakness, numbness, or changes
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-L5 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 breakdown 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.
Who is at risk 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
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. This is 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 disk disease may look like other health conditions. 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. This test uses invisible electromagnetic energy beams to produce images of internal
tissues, bones, and organs onto film.
MRI. This procedure uses a combination of large magnets, radiofrequencies, and a computer
to produce detailed images of organs and structures within the body without the use
Myelogram. This procedure uses dye injected into the spinal canal to make the structure clearly
visible on X-rays.
CT scan. This imaging procedure uses X-rays and computer technology to make 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). This test measures muscle response or electrical activity in response to a nerve’s
stimulation of the muscle. This tests to see if there is any associated nerve damage.
Discogram. This procedure uses a needle that is inserted into the disk under X-ray
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:
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
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 disk. Surgery
is done under general anesthesia. Your surgeon will make an incision in your lower
back over the area where the disk is herniated. Some bone from the back of the spine
may be removed to gain access to the disk. Your surgeon will remove the herniated
part of the disk and any extra loose pieces from the disk space.
After surgery, you may be restricted from activity for several weeks while you heal
to prevent another disk herniation. Your surgeon will discuss any restrictions with
What are possible 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.
What can I do to prevent lumbar disk disease?
Maintaining a healthy weight, participating in regular exercise, and using good posture
can lessen your risk for lumbar disk disease. Smoking increases the risk for disk
herniation and should be stopped.
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 right away 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 disk 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.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also
know what the side effects are and when they should be reported.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.