By John C. Mullan, M.D., F.A.C.S.

Damaged or worn-out lumbar (low back) disks are a common problem. A lumbar disk may bulge out and press on the spinal cord or a nerve root. This is called a lumbar disk herniation. A lumbar disk may also wear out and flatten. This is called lumbar disk degeneration. Osteophytes (bone spurs) may form on the bones near worn out lumbar disks and may put pressure on the spinal cord or nerves. The narrowing of the spaces in the spine for the spinal cord and nerves is called stenosis. Both bulging lumbar disks and osteophytes can cause stenosis. Lumbar disk problems may cause back pain and symptoms in your legs such as pain, weakness and numbness.

The most common test for lumbar disk problems is the MRI scan. The MRI scan isn’t a perfect test though and you made need other tests such as the EMG (electromyogram) or myelogram to accurately diagnose your condition.

Many times lumbar disk problems can be treated without surgery. Medications can be used to treat your pain and reduce inflammation. You may be asked to restrict your activities. Physical therapy, possibly including traction, heat, ultrasound, massage and strengthening or range of motion exercises, may help. You may be offered a trial of an epidural steroid injection.

Your neurosurgeon may advise you that surgery is recommended. This recommendation is usually made because you are not responding to other treatments or because your condition is too severe to treat without surgery. Your neurosurgeon will explain to you how your surgery is likely to affect your symptoms. It is important to remember that your symptoms may not go away completely after your procedure. Make sure that your neurosurgeon understands your expectations and that you understand your prognosis.

You may be offered a lumbar microdiskectomy. In this procedure your neurosurgeon will make a small incision in your low back and remove the damaged portion of the disk that is pressing on a nerve. An operating microscope is used to minimize the size of the incision and to maximize the safety and accuracy of the operation.

Surgery does have limitation and there are risks including bleeding, spinal fluid leak, infection, recurrence of the disk herniation and damage to the nerves or spinal cord. Your neurosurgeon will explain the specific risks of your surgery.

Many patients undergoing lumbar disk surgery are discharged on the day of surgery. Others are observed in the hospital until the next day. You will be informed of your restrictions and given an estimate of when you can return to normal activities and work. You may be asked to attend physical therapy but often this is not required. Your first check-up after surgery is usually at 4 weeks.

This brief article cannot completely cover the management of lumbar disk problems but I hope you have found it informative. Your neurosurgeon will be happy to answer your questions during your consultation.