There are 5 vertebrae in the lumbar region, they are numbered from L1 to L5 for convenience in medical terminology. For example, the abbreviation L4 – L5 refers to the 4th and 5th lumbar vertebrae. In order to be enlightening, you will find the equivalents of some terms that patients who have low back pain or diagnosed with a low back hernia and their relatives often hear, which your doctor uses, and which you frequently encounter in MR / CT reports, in the following lines at the beginning of the topic. Lumbar Disc Surgery
- Lumbar Region: Waist region
- Lumbo-Sacral Region: Coccyx-lumbar region
- Sacrum: coccyx
- Sacro-Iliac Joint: The joint made by the coccyx and the pelvis (It exists on both sides, on the right and left.)
- Lumbago: Low back pain
- Lumbosciatalgia: Pain radiates from the waist to the back of the leg along the sciatic nerve.
- Disc Herniation: Herniated disc
- Scoliosis: lateral curvature of the spine, curvature
- Lordosis: Convexity of the spine forward-facing curved state (Luminum vertebrae are typically in lordosis)
- Intervertebral: Intervertebral, intervertebral
- Postero-Lateral: Back-side
- Posterior Longitudinal Ligament: The name given to the connective tissue surrounding the spine’s face facing the spinal canal. The one on the anterior surface of the spines of this connective tissue is called the anterior longitudinal ligament.
What level of findings occurs?
- In L3 / L4 Discs: The root remaining in pressure is the L4 root, and pain or sensory defect is felt on the anterior surface of the thigh and the inner surface of the leg. The reflex that is affected is the patella (knee) reflex.
- In L4 / L5 Discs: The root that remains in print is the L5 root. Pain is felt on the outer side of the hip and leg, the back of the foot and the thumb, and numbness is felt on the outer surface of the leg and the thumb. A decrease in strength may occur in raising the big toe and foot. There is no loss of reflex at this level.
- In L5 / S1 Discs: Pain in the hip, thigh, and back of the leg, heel, and outer lower part of the foot, sensory defect on the back side of the leg and outer part of the foot. A decrease or loss in the strength of the foot towards the sole may develop. At this level, the Achilles Reflex is affected.
Lumbar hernia is one of the leading causes of back and leg pain, which is usually seen in adults. It is 1.7 times more common in men than women.
How does a hernia occur?
Lumbar hernia or disc herniation occurs when the nucleus pulposus, which loses its elasticity by degeneracy, ejects from a cleft of the annulus fibrosis with any force or wrong movement, or when the nucleus pulposus hangs from the disc space to the spinal canal together with the annulus fibrosus. As a result of herniated disc material compressing the nerve root, low back and leg pain of varying severity occurs. The posterior longitudinal ligament is strongest in the midline, so most herniated discs form to one side, right or left, compressing the nerve root and causing characteristic sciatic pain. Lumbar disc herniations often occur at the L4 / L5 and L5 / S1 levels. And accordingly, L5 or S1 roots remain under pressure. Since it forms the sciatic nerve in both roots, pain occurs in the area suitable for the root under pressure on the herniated side. With the compression of the nerve root, the muscles on the back next to the spine contract reflexively and enter into spasm, although this is actually a protective mechanism of the body, increasing pain occurs in the waist with movement due to spasm. In fact, scoliosis may develop in the spine due to muscle spasms.
Nerve root compression causes various degrees of signs and symptoms to develop.
What are the options for the patient who decides to have surgery?
- It is the known and most applied classical surgery method.
- Intervention is similar to the classical method with the microsurgical technique.
- Percutaneous endoscopic disc operation
- Laser disc decompression.