What are the lumbar discs ?
The vertebral column is made of 33 vertebrae that are separated by cartilage structures, called discs . Discs are located between the bony vertebral bodies.
What are the areas of spinal column?
Spinal column consists of 1-cervical 2-thoracic 3-lumbar and 4-sacral parts
Cervical spine or neck consist of seven vertebrae thoracic or dorsal spine which is located behind the lungs and chest area consists of 12 vertebrae
Lumber or waist or lower back Spine consist of five vertebrae. Sacral spine, or which is located behind the pelvis. Consist of five fused vertebrae .
Lumbar spine is the most important part of the body in terms of disc disease and provides weight support, and also protects the spinal cord and allows range of body motions of your waist. Lumber is fine. Consist of five vertebrae which are called L1, L2 , L3, L4, L5. Lumbar vertebrae are the largest vertebrae of the body.
What is the function of the lumbar Spine?
lumberSpine is the point of attachment of back muscles and ligaments. so it allows most of the everyday life movements like walking, running, sitting ,lifting .
lumbar spine allows movement of the body toward front and back, which are called flexion and extension and toward the side to side, which is called side bending, and also rotation of the waist. The most movement of the spine occurs in the L4– L5 and L5 – S1 levels .
lumbar Spine transfers the weight of the upper body and head and neck to the legs.
it’s the center of the balance and gravity of the body.
lumbar spine controls the movement of the legs: the nerves roots , which originate in the lumbar spine, combine together, and make the peripheral nerves which go to the muscles of the lower limbs,and control the movement and sensation of the legs.
Lumbar Spine protects the spinal cord and cauda equina.
What are the elements of lumbar Spine?
Lumbar spine consists of intervertebral discs, muscles, ligaments, and nerves and blood vessels.
What are the intervertebral discs?
Lumbar discs are cartilaginous structures , which are located between the two vertebral bodies and act like ball bearing and allow the two vertebrae move on each other. Like a ball located between two cubes so it facilitate the movement of the cubes in all directions. Indeed the Intervertebral disks are rubbery cushions that located between the two vertebrae that stack to make the Spine.
An intervertebral disc has a jelly centeral nucleus. The nucleus is encased in a stiffer rubbery exterior part, which is called annulus. A herniated discs occurs when the nucleus pushes out to a tear in the annulus compresses the neighbor nerve route.
The function of the lumbar disc is a shock absorber cushion. There are five interval discs in the lumbar area which are called L1– L2, L2 – L3, L3 – L4, L4 – L5, L5 – S1.
What are the ligaments of the lumbar spine?
ligaments are elastic structures that connect the vertebral bone to each other, stabilise the lumbar spine and allow the smooth motion of the spine, They also do not allow the vertebral bodies beyond the physiology range of motion, as well as absorb the force of trauma.
What are the name of lumbar Spine ligaments?
There are six ligaments in the lumbar spine including :
1- Anterior longitudinal, ligament, or ALL. This ligament extends in the front part of the lumbar vertebra. It is a long ligament which goes from the neck to the lumbar area.
The function of Anterior ligament is the limitation of the extension or backward bending of the lumbar spine.
2 – Posterior or longitudinal ligament or PLL attached to the posterior part of the lumbar vertebrae the function of PLL is limitation of flexion or forward bending.
3 – ligamentum flavum , or yellow ligaments These ligaments located on the back of the spine between the two laminas and protect, cover the spinal cord from behind. They are strong elastic bands, which limite the flexion or forward bending of the spine.
4- supra spinous ligaments, which are located on the tips of the spinous process of L12L3 vertebra.
5 – Interspinous ligaments: the interspinous
ligaments run between two spinous processes of the vertebrae, and cover the root to the tip of each spinous process and limite the flexion or forward bending of the lumbar spine.
7- Inter transverse ligaments :Run between the two transverse processes of the vertebrae, They limit the side bending of the back.
8- Ilio- lumber ligament joins the tip of the L5 transverse process to the iliac bone crest, which is a part of the pelvis and stabilize and limits the movement of the lumbosacral area.
What are the muscles of the lumbar spine?
There are two groups of the muscles which help to the movement of the lower back and trunk :
1- abdominal muscles, which are not attached to the lumbar spine .
2- The muscles of the lumbar spine, which are attached to the spinal column.
1-Paraspinal muscles :These are three layer muscles , which are located along the back of the lumbar spine . Para spinal muscles keep the back and body in upright position and are very important in upright posture. These muscles extend the back and help side bending and rotation of the back.
2-Iliopsoas muscles: These are consist of three group muscles which moves the hip joint and how to getting out of a chair , flex and stabilize the hip and lower back during walking, running and standing.
3-latissimus dorsi : This is a large triangular muscle, which start from the of the six thoracic Rib( T6 ) and cover the middle and the lower back. A portion of the latissimus dorsi attached to the arm. This muscle helps pull up the body weight during exercises, helps in side bending . They also help in briefing by lifting up the rib cage.
What are the nerves of the lumbar spine?
There are five pairs of lumbar nerve roots,which are called L1– L5. They branch off the thecal sac and exit from the neural foramen from the right and left side of the lumbar spine . These nerve roots, joint together and make the lumbar plexus and then they joint another time, and make the peripheral nerves which control the pain signals and movement of the lower limbs.
What is the spinal cord?
Spinal cord is the main highway of the motor and sensory signals, and extends from the brain to the L1 vertebra . The spinal cord itself ends in between L1 and L2 vertebrae(L1-L2 level) The extension of the spinal cord after L1 is a bundle of nerve roots , which called cauda equina. .it carries the motor and sensory signals between the muscles, skins a spinal cord as well as the brain.
What disease affect the lumbar spine?
There are several conditions and disorders that affect the lumber is Spine including:
1-Lumbar disc herniation:
Lumbar discs are rubbery cushions between the two adjacent vertebrae. The discs consist of two parts : 1- is a jelly like rubbery and soft part, which is located in the center of the desk called nucleus pulposus . 2- the peripheral part of the disc which is called annulus fibrosus . The annulus consist of several layers of collagen tissues, which are composed like an onion.
The herniated lumbar disc, also called bulged or ruptured disc . In this condition, the annulus fibrosus of the disc is ruptured or teared and a fragment of the nucleus pushed out of the annulus and compresses the nerve root. The most common site of the herniated disc is L4 – L5 and L5 – S1 levels. The pain of lumbar herniated disc usually worse and following standing ,sitting or walking and might decrease by lying down.
2- Degenerative lumbar disc disease: In this condition, the discs are dehydrated and degenerated so they cause back pain or sometimes sciatic pain.
3– lumbar spinal stenosis: In this condition, there is a narrowing of the space around the spinal nerve root or thecal sac , so nerve roots becomes irritated, compressed or pinch, spinal stenosis, causes low back pain or sciatica , numbness, weakness and pain of legs, groin, hips, and buttocks.
The symptoms of the lumbar spinal stenosis may become worse following walking, standing, and may decrease following, laying down, sitting or leaning forward.
4-spondylolisthesis in this condition The above vertebra slipped out forward over the below vertebra and cause nerve impingement , low back pain and leg pain.
5– Tumors of the lumbar spine, which are primary or metastasis.
6– Lumbar vertebral fractures: which are compression or burst fractures or fracture dislocation of the lumbar spine. compression fractures may occur spontaneously due to osteoporosis, but burst fractures and fracture dislocation usually occurs following accidents.
Are lumbar herniated discs common?
up to 2% of the people every year get a herniated disc. herniated lumbar discs are leading cause of back pain or sciatica.
What is the cause of low back pain?
low back pain is a common symptom of different conditions, including lumbar herniated disc , Lumbar degenerative disc diseases, lumbar spinal stenosis, spondylolisthesis, osteoarthritis,, Lumbar spinal fractures and lumbar spinal strains or sprains, Lumbar, spinal, tumors, and spinal fractures.
What is sciatica or lumbar radicality?
Sciatica is a pain, runs through the hips down to the legs and even to the foot.
What is the cause of sciatica?
The causes of sciatica including : lumbar herniated disc, spinal stenosis, spondylolisthesis, Piriformis syndrome.
What is the cauda equina syndrome?the
The cauda equina syndrome is it is an urgent and grave condition, which sometimes happenes following lumber disc herniation. In this condition the compression of several nerve roots which called cauda equina or horse’s tail causes Lower limbs paralysis , or weakness, urinary and fecal incontinence.
What are the symptoms of herniated disc?
The symptoms of lumbar herniated discs vary, depending on the position and the size of the herniated disc.isc. The symptoms of Bloom are native disks Including:
1-Lower by back pain. The lower back pain which caused by herniated lumber disc is mechanical and becomes worse following movement and activities and becomes better following rest.
2- sciatica or lumbar radiculopathy
In this situation, the pain goes from the back to the bottock , and radiates along the sciatic nerve to the feet.sciatica maybe unilateral or bilateral.
3-tingling and numbness in the legs or feet
4- muscle weakness
5- urinary and vehicle incontinence.
Can the lumbar spinal disc herniation be asymptomatic ?
If the herniated lumbar disc does not press on a nerve route, the patient may have no pain or experience only low backaches.
What is the course of the lumbar herniated disc?
Typically the herniated lumbar disc, starts with an episode of low back pain, and then a long history of intermittent episodes of low back pain or sciatica.
What is a characteristic of lumbar herniated disc sciatica?
Sciatica, caused by lumbar disc herniation, usually is unilateral, and the patient feels the pain on the left or right leg but sometimes it can be bilateral.
The pain is described as a sharp and electric shock pain. It may be more severe with sitting, standing and walking. The pain in the leg is worse than the lower back pain.
Straightening the leg on the affected side can make the sciatica worse.
Who gets this herniated disc?
What is the causes of herniated lumber disc?
Herniated lumber disc disease usually occur in people age between 30 to 50 years old. Lumbar disc herniation affect men twice as women.
What are the risk factors of lumbar herniated disc?
1-Excessive weight which put extra extras to the lumber discs.
2-Aging : lumbar disc herniation can be the result a gradual age related wear and tear which called disc degeneration . As people become older, the discs become less flexible and more prone to tearing and rupture with a minor twist or strain.
3- Strain from improper and sudden lifting or twisting . sometimes people use back muscles instead of leg and thigh muscles to lift heavy objects. The most common mechanism of lumbar disc herniation, is lifting a heavy object while twisting and turning.
4- Repetitive movements and micro traumas
5-Smoking : it is said that smoking decrease the oxygen supply to the lumbar discs in other terms, it caused ischemia in the lumber disc and make the vulnerable to break down more quickly.
6- Lifting heavy objects
7-sedentary lifestyle:sitting in the same position for a long period .
8- occupation people who have physically demanding jobs, and they do repetitive lifting, pulling, pushing bending sideways and twisting, are more prone to lumbar disc herniation.
9- Genetics some people genetically are prone to lumbar disc disease. The lumber disc is made of combination of two types of collagens, called collagen type 1 and collagen type 2. if the amount of collagen type 1 is more than collagen type 2, then the disk would be vulnerable to degeneration and disc herniation.
Also, the nucleus is composed of combination of Chondroitin sulfate and Creatine sulfute. If the amount of creatine sulfat is higher then the amount of Chondroitin sulfate,the person would be predisposed to developing a herniated lumbar disc.
9-frequent and long time driving : the vibrations from a motor vehicle engine and being seated for a long period can increase the stress and micro trauma to the lumbar discs.
How are the lumbar disc disease or herniation diagnosed?
The main and first step of lumbar herniated disc diagnosis is medical history and physical examination. The following tests are helpful in diagnosis of the lumbar herniated disc:
1-MRI or magnetic resonance imaging.
MRI is the main diagnostic tool in diagnosis of spinal column and spinal cord diseases.
Mri scanners images of the lawn Spine using a large magnet and Radio waves in this test. There is no ionizing radiation so it’s safe and noninvasive.
MRI is a cylindrical or tube shaped machine that creates a strong magnetic field around the patient’s lumbar spine . Then waves sent through the body.
The strong magnetic field causes the atoms of the body align in the same direction. The Radio waves are sent from the machine moves those atoms out of the original direction. When radio waves are turned off , the body atoms return to their original position and send radio signals to the computer.
Following calculating, the energy of these radio waves computer images produced, which are similar to the anatomy of the human body. MRI is the best diagnostic tool for the diagnosis of spinal lumber, spinal hurt, discrimination, spinal stenosis, infection, tumors.
2- x-ray, x-rays are useful for fractures and the disorders of bone part of the spinal column.
3- CT Scan: The CT scan machine uses x-ray and calculate the absorption of the x-rays to tissue and create some images, which show the spurs ,osteophyte ,bone fusion, and bone destruction , tumors and infections.
Electromyelography, or EMG is a nerve and muscle study which shows the ongoing nerve damage due to nerve compression.
What are the surgical treatment options or disc disease?
1- Lumbar laminectomy, and discectomy . The procedure is performed trough a small incision on the back over the area of herniated disc.
After the skin incision, the muscles are moved to the side, and surgeon can see the back of the vertebrae . Then the surgeon removes posterior part of the spinal column, which is called lamina. So a small opening is made between the two vertebrae to gain access to the herniated disc . The size of laminectomy depends on the size of the compressive element of the disc fragment.In discectomy the surgeon removes the portion of the disc that has been compressed the nerve root.
2-Laminotomy or inter laminator approach
In this procedure, the surgeon removes only small part of the lamina, or sometimes only removes the ligamentum Flavum . Then does the discectomy
3-Foraminectomy in this procedure the surgeon removes , bony part of the nerve exit holes which called foramen and decompress the nerve root Which exit the spinal column . This procedure, usually done when there is a concomitant spinal stenosis.
4- lumbar spine fusion
In this procedure, the surgeon perform the instrumental or non-instrumental fusion, which eliminates the movement between vertebrae. The instrumented fusion is done with vertebral cage, or by pedicle screws.
5- lumbar disc replacement surgery or artificial disc surgery
In this procedure the surgeon removes the degenerated lumbar disc and replaces an artificial lumbar disc.
In artificial disc surgery an incision is made through the abdomen and the degenerated disc is removed and replaced by an artificial disc. Artificial surgery is performed only on one level between L4 – L5 or L5 – S1 vertebrae. so a small percentage of the patients are candidates for this type of disc surgery. Patients who are candid with this type of surgery must not have osteoporosis or arthritis . If the patient has sciatica or more than one level of degenerated disc , is not a candidate for the lumbar disc replacement surgery.
6-endoscopic lumbar disc surgery
In this procedure which is called minimally invasive procedure the surgeon uses an endoscope for removing the disc material.
What is this indication of lumbar disc surgery?
1-When the pain does not go away, following six weeks conservative treatments
2- pain interferes with the daily activity and work of the patient.
3- the pain and other symptoms get worse
4-Difficulty in standing and walking
5- tingling, numbness of the lower extremities, 6-Loss of strength of the leg or feet
7-Loss of bowel and bladder control
What’s a follow up after surgery?
Usually 80% of the lumbar disc surgeries ended to a an excellent or good outcome . The Neurosergeon or the spine surgeon will give the instruction to the patient and will determine when the patient can resume the normal activities such as working , exercising, driving, etc.
What are the non-surgical treatment options for lumbar disc diseases?
1- medication including muscle relaxants , painkillers and anti-inflammatory medication which called NSAID , including ibuprofen, naproxen, diclofenac, meloxicam, piroxicam, etc.
2- physical therapy
3- bed rest, or avoid aggravating physical activity.
4- Lumbar, epidural, or facet steroid injection.
What can I do to at home to relieve the lumbar herniated disc pain?
1- Rest for three days but do some movements to prevent the stiffness
2- take over the counter,pain reliever, such as acetaminophen or ibuprofen
3-apply heat or ice to your lower back
what is the best treatment for the slipped
disc?
The best treatment depends on the to the severity of the pain and the physical condition of the patient, but usually in the first six weeks, the anti inflammatory medication or NSAID, muscle relaxant as well as physical therapy, is recommended .
Exercises is usually useful for loosening the tight muscles, and improve the circulation.
In severe pain, sometimes a shot of steroid, injected directly into the spine. This medication reduces the swelling and inflammation around the nerve root, and the body to heal faster and patient return to activity in a shorter period of time.
How can I avoid getting a herniated disc?
You can reduce the risk of getting a lumbar herniated disc by:
1- exercise regularly the workouts strengthen , the back and abdominal muscles which support the spine
2- maintain a healthy weight, excessive weight, put pressure on the back
3- exercises regularly
4- stop smoking, smoking make the disc to be variable to rupture , herniation or generation 5-Practice good posture learn how to improve your posture during walking, sitting standing and even sleeping . good posture, reduce strain to the spine .
6- use proper lifting technique keep your knee, a little bit flexed while bending forward. use the leg muscles to support the load .
7-Strech the back muscles
8-Avoid wearing high heeled shoes
What is the outlook or prognosis of the lumbar discs ?
About 90% of the people with herniated lumbar get better with conservative treatments usually during a month.About 10% of the patients need surgery to decompress the nerve roots.
Do I need a rest to relieve the back pain?
Usually up to three days rest is recommended by most of the authors during the treatment of lumbar disc herniation . Long rest makes the muscles to be stiff.
Does spinal injections, help to relieve the pain? Yes, in some cases, the physician consider spinal injection to relieve the pain.
What pain medication should I take for lumbar herniated disc ?
medication such as ibuprofen, diclofenac meloxicam, naproxen is recommended, but before taking any medication, consult your physician. muscle relaxant, such as methocarbamol , baclofen also recommended by some physicians.
How can we prevent the lumber disc herniation?
1- Exercise: strengthening the lumbar and back
muscles,, stabilize, and support the lumbar spine.
2-maintain normal weight range: normal weight range, take off the extra pressure , heavyweight from the lumbar discs.
3-quit smoking avoid the use of any tobacco products prevents the ischemia of the lumbar discs.
4-maintain a good posture: from biomechanical stand of view , keep the back straight and aligned during sitting , walking, standing for long periods, reduce the pressure and stress to the lumbar discs.
5- lift heavy objects properly: using leg and thigh muscles instead of back muscles, reduce the stress and pressure to the lumbar discs.
