Dr. Mahmoud Yazdan Panahi
Tehran
Lumbar disc rupture is one of the most common and at the same time the most painful disorders of the spine, which is mostly seen in the lower back. Lumbar disc rupture usually occurs when the outer wall of the intervertebral disc tears due to high pressure or gradual destruction of its structure, and the gelatinous interior of the disc can be caused by nerve leakage. Shooting pain in the leg, numbness or muscle weakness. everyone The cases do not require surgery.
Recognizing the symptoms in time, being aware of possible complications and choosing the appropriate treatment method, including physiotherapy and drug therapy, or more advanced methods such as minimally invasive surgery, play an important role in preventing the disease and returning to normal.. faster.
The cause of lumbar disc rupture
The lumbar disc may protrude or even rupture under certain conditions... This happens when a lot of pressure or sudden movements are applied to the spine. In some cases, the disc may be damaged even without a specific impact and only due to internal factors. Lumbar disc rupture can be a painful and very serious disease, so to avoid the dangers of this disease, it is necessary to be diagnosed by a specialist and treated in time. You can see the reasons for the dangerous nature of this condition in the list below:
- nerve compression; A ruptured disc can cause direct pressure on the spinal nerves. This pressure is often accompanied by shooting pain in the back, pelvis or legs (such as sciatica) and may also cause numbness or tingling... - muscle weakness; Nerve damage caused by a ruptured disc can affect the muscles controlled by those nerves and cause weakness, loss of strength, and even the inability to perform some simple movements... - Reduced mobility and performance... This condition can severely limit a person's range of motion and make it difficult to perform activities such as walking, bending, sitting for long periods of time or even sleeping... - Chronic and debilitating pain; In some people, the pain from a ruptured disc remains chronic and requires ongoing drug treatments, physical therapy or even surgery.... - Rare but serious complications (cauda equina syndrome).. In very severe cases, a ruptured disc can lead to cauda equina syndrome.. An emergency situation that is accompanied by numbness in the genital area, incontinence of urine or stool, and severe weakness of the legs. Lumbar disc rupture is one of the most severe types of spine injuries that can seriously reduce a person's quality of life. Like a mild lumbar disc, special attention should be paid to it to prevent the progression of the disease. Prone to damage and protrusion of the disc due to the pressure that the extra weight of the back puts on the spine, and the symptoms of lumbar disc rupture are more common in these people. be.. as well In middle-aged people, due to the gradual weakening and loosening of the outer wall of the disc, the possibility of disc rupture and protrusion of its gelatinous core increases. Of course, in elderly people, although the flexibility of the tissues decreases, the hardening of the disc wall makes the risk of disc rupture in middle-aged people who are taller a little lower. Periods of time, such as employees, drivers or people with poor posture, are at greater risk due to continuous pressure on the lumbar vertebrae..... Michael Skelcroft, a spine surgeon and lumbar disc specialist at Johns Hopkins University, says:
> "A ruptured disc is not just the result of a sudden accident, but is often the result of years of constant strain, poor posture, and neglect of spinal health. People with a sedentary lifestyle, unhealthy diet, or bad habits are more prone to this serious injury than others."
Lumbar disc rupture symptoms
We said that each disc consists of a gelatin core and a strong protein ring around it.... When the disc ruptures, the gelatin core protrudes.... The most common rupture site is the posterior part of the disc and the spinal cord is located behind the discs. The most common symptom of these patients is back pain and it has a shooting state (similar to an electric shock). The back pain of these patients is a state that means their pain is aggravated in certain positions of the body.
One of these symptoms is the presence of shooting pain in the lower limb (which passes through the pelvis, thigh and leg and may mainly reach the sole of the patient's foot). One-sided... Due to nerve pressure, the person may experience numbness in different parts of the lower body... - Muscle weakness... The strength of the muscles of the lower limb may decrease... This is also due to pressure on the nerves... - Incontinence in urine and feces; When the degree of rupture is very severe, it can also put pressure on the spinal cord... In this case, the person may lose control of their excretion and have incontinence...
Disc protrusion and rupture have different degrees... In cases where the disc protrusion is mild, up to *33*% of cases, no symptoms are observed in the person.. These cases are detected by chance in the imaging... If you did, you should definitely see a doctor... A neurosurgeon can solve your problem by prescribing appropriate drugs and surgery...
In very severe cases (such as when the back has been hit), pressure may also be applied to the spinal cord, in which case pain, numbness, and weakness are caused bilaterally in the person. These people also suffer from incontinence and may experience numbness and tingling in the genital area. The lower body may also experience numbness.
What is lumbar disc herniation? An annular rupture of the lumbar disc occurs when the thick outer layer of the disc is torn due to pressure.. After creating an annular tear, additional pressure on the disc can cause the soft and gelatinous internal substance (nucleus pulposus) to leak out of the disc.
If the rupture of the lumbar disc is severe and the appropriate treatment measures (which in these cases mainly include surgery) are not performed at the right time for the person, it can lead to permanent nerve damage for the person.. That is, the patient's leg may become numb and paralyzed forever.. For this reason, when we suspect spinal cord compression (for example, if the patient has incontinence), he should undergo surgery immediately... There is no known medical treatment for a lumbar disc, and the drugs that are prescribed to the patient are all pain relievers to control the patient's pain (while the disc heals on its own).... Analgesics that are used include:
- Acetaminophen
- NSAID drugs such as: meloxicam, piroxicam, naproxen, diclofenac, ibuprofen, etc. - narcotic drugs such as: codeine, morphine, methadone, fentanyl, pentazocine, etc.. Gastrointestinal side effects caused by NSAIDs, antacids such as omeprazole or famotidine may be used. Therefore, you should avoid driving after taking these drugs. They can be useful, but they are not approved because of the side effects they cause in case of long-term use. Some of the side effects of corticosteroids are: diabetes, blood pressure, disc physical activities, osteoporosis activities.. One of these activities is as follows:
1.... lie on your stomach
2. Bend the hands from the elbows and place them under the shoulders
3 .... raise your shoulders like swimming (Push ups); With your back and pelvis on the floor.... 4....maintain this position for 30 seconds....5....repeat this activity several times a day for 5-10 minutes....Lumbar herniated disc surgery
After 6 to 8 weeks, if the patient's symptoms do not improve and the patient's pain cannot be controlled with painkillers, the patient undergoes surgery. In this surgery, the damaged disc is removed and an artificial disc is placed. Updated reviews in 2024 and 2025 show that lumbar disc herniation surgery, especially with end microdiscectomy and microdiscectomy with discectative limb, has a success rate between 70 and 90%. .... Patients are usually short They experience a significant reduction in pain and improvement in function, and their satisfaction is reported to be around 70%... At the same time, the rate of recurrence or the need for re-surgery varies between 3 and 12%... In addition to being highly effective, minimally invasive methods have advantages such as reduced hospital stay, less post-operative pain and a faster return to daily activities.. Most cases of mild to moderate lumbar disc herniation are greatly improved.. Only less than 10% of cases require surgery. have... About 66% of people recover to a great extent within 6 months.
With rest, the pressure is removed from the gelatinous material and this material can return to its place and eliminate the pressure on the nerve... Despite the usefulness of rest, it is not recommended for patients to rest in bed for more than 48 hours. Because the person's heart and lung function decreases and problems such as osteoporosis and pulmonary embolism arise for the person. But the person should avoid heavy physical activities until full recovery... During this time, the use of painkillers can control the patient's pain... **Take lumbar disc rupture seriously!**
Lumbar disc rupture is not only the result of sudden strain or wrong movements, but also the result of a combination of internal factors such as aging, obesity, sitting for long periods of time, and a decline in the quality of disc tissue throughout life. While in the elderly, despite the reduction in flexibility, the hardening of the disc wall also slightly reduces the severity of health damage. tissue... in case of pressure on the nerve roots, a person will experience pain, numbness or even movement disability, the greatest risk of which is in the lower back. Because the vital nerves of the legs pass through this area... If the symptoms do not improve within 6 to 8 weeks, surgery will be the next effective option... The statistics of recent years show that minimally invasive disc surgery methods with a high success rate and relatively low complications have been able to keep the hope of recovery alive in many patients and return them to an active life...