Lower back

Disc Prolaps of Lower Back

What is a disc prolaps?

A spinal disc herniation, or herniation (disc prolaps) of the nucleus pulposus (HNP), occurs when part of an intervertebral disc bulges out; it is most commonly seen in the lower back (lumbar vertebrae) or in the neck (cervical vertebrae). The bulging of the disc causes it to be pushed against the nerve root. The nerve root may become irritated or trapped causing problems around the nerve root and resulting in pain that radiates to the leg.

Causes

Ageing or accidents can cause the inner part of the intervertebral disc to bulge out and a tear may even occur in the outer layer of the intervertebral disc. This causes the inner part of the intervertebral disc to be pushed forwards in the direction of the spinal canal, which is exactly where the nerve root is found. These age-related changes in intervertebral discs are normal and happen to everyone. Anyone can therefore suffer from a herniated disc in the back. A herniated disc in the back is also seen more frequently in certain families. Smoking appears to influence the development of a herniated disc, particularly the severity.

Signs and symptoms

The major symptoms in a herniated disc are pain in the lower back that radiates to one leg, or pain in the leg only but with a previous history of low back pain. In HNP the main symptom is not back pain but leg pain. Some people never have back pain. The pain often worsens upon coughing, sneezing or straining and is often sharp or stabbing. In addition, there may be a loss of feeling, tingling feelings or muscle weakness.

How is herniated disc diagnosed?

If you have low back pain that worsens upon coughing, sneezing or straining, there is a strong chance that you have a herniated disc. The neurological examination includes several tests that can confirm this.
In addition to the neurological examination, the movements of the upper back are checked for limitation and pain. The back is also examined to see if any of the vertebrae hurt when they are pressed.

Do I need additional examinations?

  • Diagnostic examination for other non-physical factors important for your pain, have already been done by yourself trough filling out your pain questionnaires.
  • As the neurological examination usually confirms the diagnosis, extra tests will not always be necessary because they will not affect the treatment in any way. It is important to know that images from MRI scan have shown that many people have a herniated disc even though they have no signs or symptoms. In the same way, MRI images of the back show that some people who have pain radiating down their leg and whose doctors think that they have a herniated disc, do not have a herniated disc at all.
  • An MRI scan is only useful in cases where there are doubts regarding the diagnosis or when surgery is considered. An MRI scan visualises the herniated disc and may show other possible causes.
  • A CT scan is usually not useful because it only provides good images of the bones.
  • It is also possible to do an examination of the muscles (EMG) in order to find out which nerve root in the back is causing the pain.
  • Nerve root test blocks are used to find out which nerve root is causing you pain in the leg.

What are my treatment possibilities?

Multidisciplinary treatment

Depending on the cause of your pain, your pain specialist will decide whether or not to start physical treatment. Based on the results of the completed pain questionnaire, additional examinations may be carried out and, apart from physical treatment, other methods of treatment will be suggested.

Non-physical treatment

If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:

Physical treatment

Medication

Interventional pain treatment