What are Lumbar Disc Herniations? 

Lumbar disc herniations occur when the soft, gel like center of an intervertebral disc in the lower back push through the annulus fibrosus, or the thick outer ring of a vertebral disc. This condition is a common cause of back and leg pain as this process creates pressure on your neural structures (nerve roots and/or spinal cord). Lumbar disc herniations are one of the most common causes of lower back pain, affecting roughly two percent (2%) of the population annually, with the most common age demographic being thirty (30) to fifty (50) year old males. 

Anatomy and Mechanics

The lumbar spine consists of five (5) vertebrae that start just below T12 at L1 and continue down your spine to the last lumbar vertebrae at L5 (L1-L5). Each of these lumbar vertebrae are separated by discs that act as shock absorbers to provide cushioning. There are also five (5) pairs of lumbar nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left.  When these discs degenerate due to age, repetitive stress, or injury they can bulge or rupture, leading to a lumbar disc herniation. This disc herniation then compresses or pinches one of your five pair of lumbar nerves that exit at each level. Herniations at each level will result in specific pain patterns, however the symptoms you experience may vary. 

Symptoms and Impact

The most common sign of a lumbar disc herniation is a shooting pain that travels along the path of the sciatic nerve and spreads down your buttock to the back of one thigh or from your buttock down to the bottom of your foot.  This compression leads to a distinct type of nerve pain that can vary from tolerable to severe. Some patients will describe their symptoms as a dull ache, while others will experience a sharp, burning sensation, numbness and tingling, or even weakness. Others may have a lumbar disc herniation and experience no symptoms. The severity of your symptoms often depends on the location and the size of herniation and its proximity to nearby nerves. 

Symptoms of Lumbar Disc Herniations: Low Back Pain and Leg Pain 

Why is Low Back Pain the Primary Symptom?

Lumbar disc herniations often initially present as persistent low back pain. This symptomatic discomfort arises when the disc herniation irritates nearby nerve roots that exit your spine. This pain often intensifies with movement or prolonged sitting, or standing significantly impacting your daily activities and sleep. 

Radiating Leg Pain

Another common symptom of lumbar disc herniations is radiating leg pain or sciatica.  Sciatica is a condition that can cause significant pain and discomfort. It occurs when your sciatic nerve, the largest and longest nerve in your body becomes injured, irritated, or compressed. Your sciatic nerve is actually not one (1) nerve, it is a bundle of five (5) nerves that branch off from your spinal cord. Your sciatic nerve extends from your low back, through an opening (sciatic notch) deep in your buttock, crosses behind muscles located deep in your hip joint, descends down the back portion of the upper thigh, to the back of your knee. Here the nerve divides into two branches. One brach continues down the back of your calf to your heel and sole of your foot. The other branch runs along the outer part of the knee to the lower leg and foot. Your sciatic nerve has both sensory and motor fibers. These fibers provide sensation, and function to your lower limbs. 

This discomfort or nerve pain typically follows the path of the affected nerve, creating a distinct pain pattern known as a dermatome. Sciatica specifically involves pain that radiates from your low back, down the back of your thigh or from your low back to the bottom of your foot. This is often described as numbness or tingling with a heightened sensitivity to touch. 

Additional Symptoms

Lumbar disc herniations can also lead to more severe symptoms. In addition to low back pain and radiating leg pain you may also experience:

• • Muscle weakness or difficulty moving certain body parts
  • Change in your reflexes
  • Changes in your bladder or bowel function. 

Changes in your bladder or bowel function often are indicative of a more serious disc herniation that requires immediate medical attention. 

Causes and Risk Factors for Lumbar Disc Herniations

• • Aging

• • Being overweight

• • Poor posture

• • Improper lifting techniques

• • Repetitive motions

• • Smoking

• • A family history of degenerative bone conditions

Diagnosing Lumbar Disc Herniations

Physical Examination & History 

Lumbar disc herniations are typically diagnosed by reviewing your medical history and a thorough physical exam. Your physician may ask various questions about the location of your pain and symptoms. Your physician will assess your pain levels, reflexes, muscle strength, and sensations in your legs and feet.. Finally you may be asked to perform specific movements to evaluate your range of motion, and to help identify the location and severity of your herniation.

Imaging Studies

If your physician suspects a lumbar disc herniation they may order imaging studies to confirm your diagnosis. Depending on your specific diagnosis x-rays, MRIs, or CT scans are commonly utilized to visualize your spine, detect abnormalities, and confirm your diagnosis. These studies can reveal the exact location of your herniated disc and the extent of your nerve compression. This information combined with the results of your physical examination will be crucial for developing an effective treatment plan. 

If your lumbar disc herniation is caused by a significant lumbar disc herniation, spinal stenosis, degenerative disc disease, or spondylolisthesis your physician may recommend a surgical procedure.

Nerve Conduction Tests

Your physician may recommend nerve conduction studies or electromyography (EMG) to access the function of your nerve. EMGs can help identify specific nerves that are affected by the lumbar disc herniation and measure the degree of damage to the nerve. This test provides value information in diagnosing lumbar disc herniations, and distinguishing from other causes of low back pain and leg pain. 

Treatment Options for Lumbar Disc Herniations

If you have been diagnosed with a lumbar disc herniation and are experiencing symptoms conservative treatment modalities are typically exhausted as an initial treatment recommendation. Symptoms from lumbar disc herniations may heal on their own with time and conservative treatment. If your symptoms do note resolve your physician may recommend interventional pain procedures, medications, and physical therapy. The procedures work to reduce inflammation around the nerve root, often times resulting in significant pain relief. If your symptoms still persist, and significantly impact your daily activities your physician may recommend a surgical procedure.  To help relieve pain often associated with lumbar disc herniation, treatments may includes: 

• • Heat or cold therapy
  • NSAIDs
  • Physical therapy
  • Massage 
  • Epidural steroid injections
  • Nerve blocks
  • Microdiscectomy
  • Laminectomy 
  • Spinal fusion

Potential Long Term Effects of Ignoring Lumbar Disc Herniations

Nerve Damage and Neurological Complications

Prolonged untreated nerve compression from lumbar disc herniations can lead to permanent nerve damage. This may result in muscle weakness, loss of sensation, or even paralysis. Significant lumbar disc herniations can compress the bundle of nerves at the lower end of your lumbosacral spine call the cauda equina. This nerve sends and receives message to and from legs, feet, and pelvic organs. Cauda equina syndrome is the symptomatic compression of this nerve, and often results in emergent surgery.  

Spinal Instability and Increased Risk of Surgery 

Untreated lumbar disc herniations can contribute to progressive spinal degeneration and instability, they may progress to additional complications such as spinal stenosis or spondylolthesis. As the condition worsens over time, more complex and invasive surgical procedures may be necessary to address and alleviate your specific condition and symptoms. 

Why Choose Kalra Brain & Spine to Help Manage Low Back Pain & Leg Pain? 

“My decision to fly from Montana to Texas for the surgery that was necessary, was the RIGHT thing to do! The hospital where surgery was performed was excellent as well. Tiny little place with excellent nursing staff. I was given a clean bill of health today and released to do as I please now. My lumbar fusion was a total success ! I could never find the level of care in my home town as I have found with Dr. Kalra in Texas ! If you have spine issues, Dr. Ricky Kalra is an amazing surgeon. Best decision I have ever made regarding my medical care. ‍”

Yvonne M.

“A huge thank you to Dr Kalra and his team for successfully healing my back!  I was not a believer in undergoing surgery, I felt certain I could overcome my injury with other forms of therapy but the MRI said otherwise.  Dr. Kalra performed a Lumbar Fusion (L2/L3) and I woke up after the surgery, pain free. I was careful to follow his plan for post-op, starting with PT and then moving into more exercise such as swimming, cycling and light weight lifting and now after 12 months, I have been cleared for all normal activity.  My husband and I are looking forward to hiking at Zion National Park in September.  He’s given me my active lifestyle back and I am so happy!”

Julia M. 

“One year ago to the exact date,  I was on an operating table undergoing a 360 L4-5 back surgery and today I’m back to playing pickleball thanks to the expertise and follow up care of Dr. Kalra and his medical team. If you’re experiencing back pain, you will not be disappointed seeking out a consult or second opinion from Dr. Kalra. He uses a conservative, least restrictive multi modal approach. Surgery is often a last resort. His office is run very personably and efficiently. I experienced very little wait time, yet he and his wonderful PA’s gave me all the one on one time I needed, during the actual visit, answering all my questions without rushing.  The office staff quickly responded to my phone calls and any prescription changes or refills were called in promptly. It’s a top notch run “operation” in all ways!

Carol S. 

“I recently took my father to see Dr. Kalra since he was having very bad low back pain. I was very pleased with the way Dr. Kalra sat and explained in detail what could be causing it and laid out all of our options on what he can do to help my father. He actually listens to his patients needs and thoroughly explains what needs to be done, My father was nervous at first but when we met Dr. Kalra and his staff they put my fathers mind at ease. Hands down the best at what he does and would highly recommend him.”

Jaime S. 

“Wow! Where do we even begin with Dr. Kalra and his office. My mother had a bad disc fragment impinging on a nerve root in her back giving her excruciating pain down her leg for quite some time.  She had seen back doctors before, however her experience with Dr. Kalra was nothing like she’d had before. We were very impressed with Dr. Kalra’s level of professionalism, efficiency, and overall treatment approach.  He gave my mom every possible chance to avoid surgery, however in the end, it just wasn’t in the cards for her.  He showed compassion and empathy in all aspects of patient care. He was very patient, and took time to explain all options during hospitalization. He rounded on my mother in person, as well as his PA, and both displayed wonderful bedside manner.  After surgery, my mother’s pain was immediately gone, able to walk unassisted, and was able to return home the very next day.  He kept myself and my family fully updated the entire time she was in the hospital.  Nobody takes on a personal touch like Dr. Kalra, and because of that, I highly recommend Dr. Kalra and his staff to anyone in need of a spine surgeon in the metroplex and beyond. I am so grateful we traveled the distance for his exceptional care! He and his team deserve 10 stars!

Mindy C. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. If you have unanswered questions about your back pain, need a second opinion, or to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.   

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Understanding Your Spinal Anatomy

Understanding the anatomy of your spine’s structure will help to better comprehend radiculopathy and sciatica. Your spine works to support your body, allows you to be flexible and move, as well as protects your spinal cord and nerves. A healthy spine will have an S-shaped curve. Your neck and low back have soft forward curves, while your mid back and sacral spine have small backwards curves. These natural curves aid in movement and shock absorption. These curves and your spinal discs aid in distributing weight and forces evenly through your spine. If your spine was straight instead of an S-shape it would take tremendous wear and tear creating significant spinal disorders. These S-shapes allows a portion of the weight and forces to be distributed to your spinal discs, and not solely to the vertebrae below much like a spring. Overtime, this wear and tear with the aging process result in degeneration of these discs. 

What Structures Make Up Your Spine?

The structure of your spine consists of over one-hundred twenty (120) muscles, two-hundred twenty (220) ligaments, one-hundred joints (100), thirty-three (33) vertebrae. Your spine consists of many complex structures:

• Vertebrae are the small bones that are stacked or aligned to created your spinal canal. These thirty-three (33) bones protect the delicate structures of your spinal cord and nerves

• Intervertebral discs are the flat round cushions that sit between each vertebrae and act as shock absorbers. Each vertebral disc has a soft gel like center with a tougher but flexible outer ring. Under pressure or intense forces this inter gel like center can squeeze out through the outer ring of the disc causing a herniation. This disc material can thencompress your nerves or spinal cord resulting in sciatica or radiculopathy.  

• Spinal cord and nerves make up your spinal canal and run under the vertebrae from the base of your skull to your low back. Thirty-one (31) pairs of nerves branch off from your canal through small openings in the vertebrae. These nerves carry messages between your brain to your muscles. When disc material compress these nerve roots  you often end up with nerve pain referred to as radiculopathy. 

• Facet joints are the connections between each spine level. These are located on the posterior (backside) of the vertebral body and provide structural stability to the spine.   They also limit and guide the motion of each spinal level. These joints can be a significant source of pathology including arthropathy, infection, inflammation, tumors, and trauma. 

• Soft tissues are the non-bony and non-disc aspects of the spine that are primarily muscles, ligaments, and tendons. These muscles and ligaments provide stability, strength, and facilitate spinal movement. Injuries to soft tissues of the spine may be tears or sprains/strains such as whiplash. 

What Are the Different Segments of the Spine? 

The thirty-three (33) vertebrae and thirty-one (31) pairs of spinal nerves that comprise your spine are divided into five segments: 

• Cervical vertebrae are the first seven (7) vertebrae of your spine in your neck. These levels are identified as C1 being the first and highest neck bone through C-7 being the last (C1-C7). There are eight pairs of cervical nerve roots, with one member of the pair exiting on the right side your vertebrae, and the other on the left side. 

• Thoracic vertebrae are the vertebrae located in your upper-mid back. These twelve (12) vertebrae or levels start just below the last cervical vertebrae at T1, and continue down the spine to T12 (T1-T12). There are twelve (12) pairs of thoracic nerve roots that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Lumbar vertebrae are the vertebra located in your low back. These five (5) vertebrae start just below T12 at L1 and continue down your spine to the last lumbar vertebrae at L5 (L1-L5). There are also five (5) pairs of lumbar nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Sacral vertebrae are the vertebrae that are located in your pelvis. These five (5) vertebrae start below L5 at S1 and continue down your spine to the last sacral vertebrae at S5 (S1-S5). There are also five (5) pairs of sacral nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Coccyx vertebrae are four (4) small vertebra that are fused together to form your tailbone. There is only one (1) pair of coccygeal (Co1) nerves that meet in the area of the tailbone. 

What is Radiculopathy? 

Radiculopathy is a medical condition characterized by compression, irritation, or inflammation  of spinal nerve roots, this leads to pain, numbness, tingling, or weakness along the path of the affected nerve. This condition can occur in the cervical, thoracic, or lumbar regions. Radiculopathy most commonly occurs in the cervical and lumbar areas of the spine.

Common Causes

• Spinal stenosis

• Degenerative disc disease

• Bone spurs

• Spinal injury or trauma

• Herniated discs 

Symptoms and Presentation

Symptoms of radiculopathy vary depending on the location of the affected nerve root.

• Decreased sensation in the skin

• Numbness of tingling sensations

• Sharp burning pain that radiates along the nerve path

• Muscle weakness or loss of reflexes

Diagnosis and Treatment

To properly diagnose radiculopathy your physician will typically review your medical history, conduct a physical examination, and order imaging studies such as a x-ray, MRI, or possible nerve test called EMG. Fortunately, the majority of patients can obtain relief of their symptoms with conservative treatment modalities and time. Initial conservative modalities may include anti-inflammatories, physical therapy, and activity modifications such as avoiding activities that cause strain to the back or neck. If you do not respond to the initial course of conservative treatment a referral to pain management may be recommended to obtain an epidural steroid injection or nerve block. For most patients, this will help reduce inflammation and nerve irritation to lessen the symptoms of radiculopathy. You may need additional repeat injections if you did not achieve relief of your symptoms, or if the relief of your symptoms was not lasting. 

Unfortanently, some patients will exhaust conservative treatment modalities and not achieve symptom relief. In this situation your chronic nerve pain may be affecting or limiting your daily activities. This persistent discomfort can make routine tasks feel like monumental challenges. At this point surgical intervention such as a microdiscectomy or laminectomy may be appropriate to consider. A microdiscectomy is a minimally invasive surgery to remove the portion of herniated disc material. A laminectomy is performed by removing a portion or all of the lamina (vertebral bone). This helps create space to relieve pressure on your spinal cord or nerves. A proper diagnosis and early intervention can significantly improve your outcomes, hopefully allowing you to avoid a surgical procedure. 

Understanding Sciatica

Sciatica is a common condition that can cause significant pain and discomfort. It occurs when your sciatic nerve, the largest and longest nerve in your body becomes injured, irritated, or compressed. Your sciatic nerve is actually not one (1) nerve, it is a bundle of five (5) nerves that branch off from your spinal cord. Your sciatic nerve extends from your low back, through an opening (sciatic notch) deep in your buttock, crosses behind muscles located deep in your hip joint, descends down the back portion of the upper thigh, to the back of your knee. Here the nerve divides into two branches. One brach continues down the back of your calf to your heel and sole of your foot. The other branch runs along the outer part of the knee to the lower leg and foot. Your sciatic nerve has both sensory and motor fibers. These fibers provide not only sensation, but function to your lower limbs. 

Common Symptoms

The primary attribute of sciatica is a shooting pain that travels along the above path of the sciatic nerve and spreads down your buttock to the back of one thigh or from your buttock down to the bottom of your foot.  This compression leads to a distinct type of nerve pain that can vary from tolerable to severe. Some patients will describe their symptoms as a dull ache, while others will experience a sharp, burning sensation, numbness and tingling, or even weakness. 

Common Causes

Numerous factors can contribute to the development of sciatic:

• • Herniated discs occur when the soft inner portion of a spinal disc protrudes through the tougher outer shell, often times pressing on the nerve roots that exit the spine.

• • Spinal stenosis is a condition where the spinal canal narrows, which can also put pressure on surrounding nerves. 

• • Spondylolisthesis is when a vertebra moves or slips out of place compared to the subsequent adjacent vertebrae. 

• • Compression fractures occur when there is a fracture in a vertebra causing it to collapse.

• • Osteoarthritis or spinal arthritis occurs from wear and tear or degenerative changes in the spine.

• • Scoliosis is an abnormal sideways curvature of the spine. 

Risk Factors

Risk factors for developing radiculopathy include:

• • Aging

• • Being overweight

• • Poor posture

• • Improper lifting techniques

• • Repetitive motions

• • A family history of degenerative bone conditions

• • Smoking

Diagnosis and Treatment

Sciatica is typically diagnosed by reviewing your medical history and a physical exam. Your physician may ask various questions about the location of your pain and symptoms. Additional diagnostic studies such as x-rays, magnetic resonance imaging (MRIs), or elcectomygraphy (EMG), may be recommended.  Sciatica will usually heal on its own with time and conservative treatment. Sciatica often results from a spinal issue that puts pressure on the sciatic nerve. If your sciatica is caused by a lumbar disc herniation, spinal stenosis, degenerative disc disease, or spondylolisthesis your physician may recommend a surgical procedure. To help relive the pain, treatment often includes:

• • Heat or cold therapy

• • NSAIDs

• • Physical therapy

• • Epidural steroid injections

• • Nerve blocks 

• • Massage 

• • Microdiscectomy

• • Laminectomy 

Common Symptoms of Radiculopathy and Sciatica 

Pain Sensations and Pattern

The classic symptom of both radiculopathy and sciatica is radiating pain. This discomfort or nerve pain typically follows the path of the affected nerve, creating a distinct pain pattern known as a dermatome. With radiculopathy you may experience sharp, burning, or electric like pain that travels from your spine to your extremities. Sciatica specifically involves pain that radiates from your low back, down the back of your thigh or from your low back to the bottom of your foot. With this pain you may also be experiencing:

• • Muscle weakness or difficulty moving certain body parts

• • Numbness or tingling sensations in the affected area

• • Heightened sensitivity to touch

Location Specific Symptoms

The location of your symptoms provide valuable clues about which spinal nerves are being affected. When a spinal nerve is compressed, irritated, or injured it may be on the left, right, or both sides of your spine. All three locations will produce varying symptoms. 

• • Cervical radiculopathy involves pain, numbness, or weakness in your neck, shoulder, arm, or hand.

• • Thoracic radiculopathy involves discomfort in your upper abdomen or chest wall.

• • Lumbar radiculopathy (including sciatica) involves pain in lower back, buttock, leg, or foot. 

While radiculopathy and sciatica are often used interchangeably, radiculopathy and sciatica are not the same. Sciatica refers to symptoms caused by compression or irritation of the sciatic nerve, and is actually a type of lumbar radiculopathy. Remember all cases of sciatica are radiculopathy, but not all radiculopathy is sciatica. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. If you have unanswered questions about your arm or leg pain, need a second opinion, or to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.   

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