Background
A hernia at this level tends to press on the nerve of the same name, causing pain in the lower back, as well as the sciatic nerve, which would cause pain in the back of the leg, in the calf and possibly in the foot, as well as numbness and tingling in the affected lower limb. For this reason, a herniated lumbar disc usually produces sciatica (pain that is caused by compression of the sciatic nerve root) but not back pain itself.
This disc herniation may become significant if a nerve root is compressed. The irritation of a nerve root causes pain along the nerve, typically the back of the leg, one side of the calf and possibly to one side of the foot.
If you are sensory function of the nerve root involved, there might be insensitive. The exact sensitivity is lost deteminada by the particular root, and may be the inner ankle, the toe, heel, the outer ankle, the outer leg, or a combination thereof. If you are involved in motor function of the root will cause weakness which again depends on the particular root, and may include weakness or collapse the stretch to lift the ankle or toe.
| Manifestation | Discal Herniated Level | ||
|---|---|---|---|
| L3-L4 | L4-L5 | L5-S1 | |
| Compressed Root | L4 | L5 | S1 |
| Weakness | quadriceps, anterior tibia | extension of the big toe | Ankle flexion |
| Reflex Implication | knee jerky | not significant | Achilles tendon |
| Sensorial Loss | middle ankle | big toe | foot and heel side |
| Pain Distribution | front thigh | back thigh | back part thigh, side calf |
Table. The most common clinical manifestations of lumbar disc herniation. (Spanish).
Table summarizes the main sídromes of lumbar disc herniation. Note that the L5-S1 disk is involved in 45-50% of cases, L4-L5 40-45%, and L3-L4 about 5%. Disc herniation at other lumbar levels is rare. The root compressed is the one below in most cases. However, if the herniation is lateral, into the hole, the compressed root is the one above. This type of hernia is rare and occurs in 3-10% of cases. It is also important to note that although signs are helpful in diagnosis and determining the type of treatment could not be present all the symptoms related to a particular root, and still be symptoms related to multiple roots.
Diagnosis.
Clinical, that is, through the clinical history, where a good interrogation and detailed physical examination is necessary. Once you have a way forward, suspicions are confirmed through imaging studies, the most commonly used being simple radiography and magnetic resonance, these studies allow you to define the location and configuration. Computed tomography is used to detail the bone and is not very useful for detailing soft tissue.
What possibilities do I have to improve, if you do not operate me?
In the best case, the patient with low back pain or in one leg, due to a herniated disc, improves in about 4 weeks. However, if after about a month and a half, the symptoms remain the same or a worsening has occurred, you should consult with your specialist doctor. If, in addition to pain, you notice a clear decrease in strength in the foot, if you have difficulty retaining urine, if you have lost weight or if the pain is more intense at night, go urgently to a specialist, without the need to wait 4 or 6 weeks.
