Lumbar Disk Disease

Lumbar disk disease refers to degenerative or structural changes affecting the intervertebral disks in the lower back. The lumbar spine consists of five vertebrae (L1–L5), separated by spongy disks that act as shock absorbers. Over time, these disks may lose hydration and elasticity, becoming more vulnerable to bulging or rupturing.
Two main disk problems commonly occur:
Bulging Disk
Aging and disk dehydration cause the disk to compress and the tough outer layer (annulus fibrosus) to weaken. The inner portion (nucleus pulposus) then protrudes outward, forming a bulging disk.
Herniated (Ruptured) Disk
With further degeneration or stress, the nucleus pulposus can break through the annulus and press on nearby nerve roots. This pressure can lead to pain, numbness, weakness, or sensory changes.
Herniations most commonly occur at L4–L5 and L5–S1.

Lumbar disk disease results from structural changes within the disk. Factors include:

Natural aging and disk degeneration
Loss of hydration and elasticity of the disk
Severe injury resulting in disk rupture
Prior trauma worsening an existing herniation

Certain conditions increase the likelihood of developing lumbar disk disease:

Aging (most significant risk factor)
Physical inactivity, leading to weak core muscles
Sudden strenuous activity in people who are normally inactive
Occupations requiring heavy lifting, bending, or twisting
Repetitive stress injuries
Poor posture
Obesity, which increases spinal load

Symptoms vary depending on the location of the herniation and the affected nerve root. Common symptoms include:

Intermittent or constant back pain, worsened by movement, coughing, sneezing, or standing
Back muscle spasms
Sciatica — pain radiating from the back or buttock down the leg into the calf or foot
Leg muscle weakness
Numbness or tingling in the leg or foot
Reduced knee or ankle reflexes
Changes in bladder or bowel function (a red flag requiring urgent medical care)

Diagnosis involves a medical history, physical examination, and one or more advanced imaging or nerve studies:

X‑ray: Evaluates bone alignment and structural issues
MRI: Best tool for visualizing disks, nerves, and soft tissues
Myelogram: Highlights spinal structures using contrast dye
CT Scan: Provides detailed bone and soft-tissue imaging
Electromyography (EMG): Evaluates nerve and muscle function
Discogram: Uses contrast injected into the disk to identify painful disk levels

Conservative (First-Line) Treatment
Most patients improve with non-surgical management, which may include:

Bed rest (short-term)
Education on proper body mechanics
Physical therapy (ultrasound, massage, stretching, strengthening exercises)
Weight management
Lumbosacral back support
Medications (pain relievers, anti-inflammatory drugs, muscle relaxants)

Surgical Treatment
If conservative methods fail or symptoms worsen, surgery may be recommended:

Performed under general anesthesia
A small incision is made in the lower back
A portion of bone may be removed to access the disk
The herniated disk fragment and loose material are removed to relieve nerve pressure
Typically requires several weeks of activity restriction to prevent re-herniation