Back

Symptoms caused by a herniated disc in your lumbar spine include:

• Pain in your leg, especially in the buttocks, thigh, and calf
• Numbness or tingling in your leg
• Weakness of your leg

Pain is caused by inflammatory chemicals that are released around the injured area, and the injured disc can also put pressure on the nerve roots as they travel through the adjoining tunnel to and from the spinal cord. This can cause pain, pins and needles and numbness into your leg and also lead to significant muscular weakness.

Most people with mild disc herniation will improve on their own in about six to eight weeks. For other people, the pain will be more intense and persistent and physical therapy may be indicated to help alleviate symptoms. Anti-inflammatory medication and pain relievers may also be necessary.

In a small group of people, symptoms don’t respond to conservative measures or time. When this is the case, Dr. Soldevilla may recommend surgery, particularly if there is persistent pain or weakness in your legs. When surgery is indicated, it is usually aimed at reducing the pressure from the herniated disc on surrounding tissues and is especially focused on relieving any pressure on the nerve roots as they exit from the spinal cord. This should relieve any pain or sensation traveling down into your legs.

Fortunately, recent technological advancements in spinal surgery have led to much less invasive procedures for disc herniation. Afterward, most patients enjoy a faster recovery.

There are several different types of surgical procedures for herniated discs. Dr. Soldevilla will discuss these procedures with you and together you will choose the one that is most suitable for you.

With lumbar radiculopathy, pain can radiate anywhere along the buttock/leg/foot area. Other symptoms in this area can include:

• Numbness
• Altered reflexes
• Weakness
• Tingling

Radiculopathy of the back can be treated in a number of different ways, both surgical and non-surgical. Non-surgical treatments are typically the first line of treatment and can include:

• Rest or activity modification
• Physical therapy
• Ice and/or heat therapy
• Medication including over-the-counter anti-inflammatory drugs and/or pain relievers
• Manual manipulation
• Epidural steroid injection

If non-surgical treatments don’t provide the pain relief you are looking for, surgery could be the next step. There are a number of different surgical solutions, depending on the cause of the lumbar radiculopathy, and typically focus on decompressing the nerve and/or stabilizing the spine.

A lumbar disc herniation in the lower back may result in:

• Shooting pain into the buttocks or down the leg
• Local severe back pain or “burning” in the back
• Weakness in one or both legs
• Changes in bowel or bladder activity
• Lack of sensation or pins-and-needles tingling in one or both legs

Despite the fact that the physical degeneration in your spine will gradually progress over time, the good news is that your symptoms may not necessarily progress to the same extent. Sometimes, symptoms can even improve over time. A number of studies have shown that pain levels in this condition are actually worse in younger people than older. There are a few reasons why this may be so – the joints in the back tend to stiffen up with age, leading eventually to more stability; and also, the inflammatory chemicals that are contained within the nucleus pulposus can eventually become depleted.

For some people, however, particularly if the pain levels are severe, or if there is pressure on the nerve roots, symptoms will continue to escalate with time.

Most people with degenerative disc disease respond well to conservative, non-surgical treatment. This conservative treatment typically includes anti-inflammatory medication and pain relievers. Physical therapy can help to manage your symptoms and may include manual therapy, heat and other pain-relieving methods, stretching, strengthening exercises and education to help you manage your condition.

For a small group of people who don’t respond to conservative treatment, surgery may be necessary, particularly if there are signs and symptoms of nerve compression or joint instability. There is a wide range of surgical techniques that may be used for this condition, depending on the extent and exact nature of the damage to the disc and spine. Dr. Soldevilla will discuss with you fully the type of surgery he recommends for you and will work with you to develop a treatment plan.

Spondylolisthesis symptoms range from mild to severe. Depending on the severity of the condition, the following symptoms may be present:

• Pain in the lower back, often worse after walking or exercise, or extending the back (straightening or leaning back)
• Stiffness in the lower back
• Increased tightness of the hamstrings
• Pain, numbness, or tingling in your legs if nerves are being compressed
• Loss of control of bladder or bowel function (in severe cases)

Dr. Soldevilla will first carry out a thorough assessment to determine the severity of your condition. Spondylolisthesis will usually be evident on plain x-rays but further scans such as an MRI or CT scan may be ordered to see if there is pressure on other structures, such as nerves or the spinal cord.

In less severe cases, physical therapy may be helpful. This treatment may consist of manual therapy, stretches to address the tightness of hamstrings and other structures, and strengthening exercises for your core muscles to help support your back. Your doctor may also prescribe medication to help manage your pain and reduce inflammation. A back brace is sometimes used to stabilize the area.

For a number of people with more severe forms of spondylolisthesis, surgery is recommended, especially if the slippage is severe or if there is pressure on the spinal cord or nerves. The goal of surgery is to provide more space for the spinal cord and nerve roots while stabilizing the spine. In some cases, it can also be effective at reducing pain. Dr. Soldevilla will discuss with you the most appropriate surgical technique for your condition.

Symptoms may include:

• Back pain
• Radiating pain into the legs, especially when moving
• Leg weakness and/or numbness
• Difficulty standing or walking
• Change in bowel or bladder function

Often, a conservative treatment of physical therapy, anti-inflammatory medication, and/or pain relievers may be sufficient to alleviate symptoms of stenosis.

However, Dr. Soldevilla will typically recommend surgery if there are signs that the spinal cord or nerves are compressed. Surgery is necessary if neurological symptoms increase, such as difficulty with balance or walking.

If Dr. Soldevilla feels surgery is your best option, he will take the least invasive approach he can that will give you the optimal outcome, and will fully discuss his recommended procedure with you.

Symptoms may include:

• Pain in the lower back
• Pain in one or both legs
• Pain that radiates down the back of the leg and to the feet
• Leg cramps
• Tingling or numbness in one or both legs
• Increased symptoms when standing that eases when sitting

Patients with synovial cysts can often control their symptoms through activity modification, non-surgical treatment for pain relief (i.e. NSAIDS, pain relievers), injections, and/or physical therapy.

Dr. Soldevilla may recommend surgery if there are signs that the spinal cord is compressed or there is significant risk that the spinal cord may become damaged. Surgery is necessary if neurological symptoms increase, such as difficulty with balance or walking.

The most reliable kind of spine surgery for synovial cysts is decompression surgery combined with spinal fusion, during which the cyst is removed and, occasionally, the joint fused. Once the joint is fused, all motion is stopped in that particular area, so the cyst is unlikely to regenerate.