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Lumbar Herniated Vertebral Disc
Lumbar Herniated Vertebral Disc
Also referred to as “Sciatica” or intervertebral lumbar “Slipped Disc” in common terms, this affliction occurs in mid-life and affects the intervertebral discs of the lumbar spinal region. A precondition for the occurrence of a slipped disc is general wear and tear of and damage to the ring of fibrocartilage and fibrous tissue forming the circumference of the intervertebral disc (annulus fibrosus). One differentiates between a herniated vertebral disc (a condition of the vertebral disc tissue with disruption of the annulus fibrosus) and a protruded disc (warping with the annulus fibrosus intact). Damage to a disc caused by injury is very rare. The displaced spinal disc tissue compresses one (or more) nerve roots, resulting in pain and in some cases neurological mal-function. 20-30% of people are affected by this. The two lower intervertebral disc segments L4/5 and L5/S1 are the most frequently affected (approx. 80%). The first physical discomfort may appear at as early as age 20. Peak period for this condition: Age 30–45. Other pain syndromes may also occur at a later time due to mal-positioning of the spinal column.
Therapy: physiotherapy and chiropractic manipulation strengthen the abdominal and back musculature, correct mal-positioning and maintain flexibility of the affected areas of the spinal column. Further measures include massage, heat application (fango treatment / hot air), electrotherapy, targeted injections or acupuncture; elimination of excessive load in the spinal column area; career counselling; elimination of excessive physical activity, and elimination of heavy lifting or carrying. These measures should be accompanied by weight reduction and/or regular physical activity (fitness program, callisthenics, pilates, back school, swimming, yoga, etc.).
Prognosis: the outlook is generally favourable; the treatment, however, is time consuming (3–6 months). A reduction in discomfort can be achieved by a retraction of the herniated vertebral disc and volume reduction, by cicatrisation or avoiding the nerve root in the bony foramen. Complications resulting from the condition (cauda-syndrome, bladder and rectal disturbances) are rare. An intervertebral disc surgery is necessary in only a few cases (approx. 10%) (discectomy, interlaminar windowing, sequestra removal, a combination of dorsal intervertebral disc removal, reconstruction and replenishment of the intervertebral disc area, in some cases with a stabilizing titan cage interposition, or implant of an artificial intervertebral disc).