High-Level Herniated Discs: Symptoms and Treatment Options

High lumbar disc herniation (T12-L1, L1-L2)

In June 2022, I visited the hospital due to severe pain in the left posterior hip and mild numbness, along with pain in the left lower back.
After an X-ray, the doctor mentioned that it was unusual for someone in their twenties to have a somewhat narrowed spine, so I was referred for an MRI.
The report confirmed a herniated disc at the T12-L1 and L1-L2 levels, but did not mention any narrowing issues, only stating that such a high-level herniation is quite rare.
I was advised to continue with heat therapy, electrical stimulation, and spinal traction.
During the treatment process, it was noted that while I could only lift the affected leg about 30-40 degrees when lying flat, I experienced no pain when bending forward, but pain occurred when leaning backward, with the pain localized around the L1 area.
The physical therapist observed that the lumbar vertebra in that region was particularly prominent, although the orthopedic doctor did not specifically mention this during the review of my imaging.
I have been attending therapy sessions 3-4 times a week for heat therapy, electrical stimulation, and spinal traction, without interruption since February 2023, except during the Lunar New Year and occasional business trips.
Starting in October 2022, I began weekly manual therapy sessions at a physical therapy clinic.
The therapist also instructed me to perform some rolling and stretching exercises at home for my lower back, hips, and thighs, dedicating at least 40 minutes daily.
However, I find that the recommended McKenzie exercises are difficult due to the pain when leaning backward, so I can only tolerate a slight elevation that does not trigger pain.
The therapist advised that I should only elevate to a height that does not provoke pain.
Currently, despite daily stretching, after a full day at work (I work in an office but follow medical advice to alternate between sitting and standing every half hour), I still return to the tightness I experienced before stretching the previous day.
It feels like I am starting over each day.
There have been instances where I was too fatigued to stretch for two or three days, resulting in tightness that made it difficult to lift my thigh and slightly challenging to climb stairs.
Since then, I have been diligent about stretching before bed.
If I engage in activities that require prolonged walking or standing, my symptoms tend to worsen, leading to sharp pain and electric shock sensations.
Summary of affected areas: Left lower back, left posterior hip, left lower abdomen.

Symptoms: Soreness, pain, burning sensation, pain when leaning backward near L1, occasional sharp pain, occasional electric shock sensation, numbness (which has improved after three months of rehabilitation).

Questions:
1.
Is it possible for high-level herniated discs to cause symptoms like pain when leaning backward, which is typically associated with spondylolisthesis? There is very little information available online regarding high-level disc herniations, so if there are other symptoms associated with high-level herniated discs, I would appreciate any additional insights.
2.
Why do my muscles feel tight every day? It seems that after stretching, they return to tightness the next day, making it feel like I am not making progress.
Although my symptoms have improved significantly since the beginning, I feel stuck after three months without further improvement.
I am eager to progress to core strengthening exercises, but my symptoms worsen with activity, leading to three sessions of manual therapy per week.
Are there any other methods or treatments you would recommend? I have heard about PRP therapy, but it seems to address symptoms rather than the underlying issue.
Do you have any other thoughts on this?

Li, 20~29 year old female. Ask Date: 2023/02/10

Dr. Wang Zhaomin reply Rehabilitation

Pain triggered by backward bending is not exclusive to spondylolisthesis; other spinal disorders or lower back issues may also cause similar symptoms.
Conservative treatment options have generally been attempted, and it is advisable to continue with the aforementioned therapies.
Further injection therapies can also be considered to alleviate pain, which may help in training the core muscle groups.
If there is no improvement in treatment outcomes or if symptoms worsen, surgical intervention may need to be considered.

Reply Date: 2023/02/10

More Info

Understanding high-level herniated discs, particularly in the lumbar region, involves recognizing the symptoms, treatment options, and the underlying mechanics of spinal health. A herniated disc occurs when the soft inner gel of the disc protrudes through a tear in the tougher exterior. This can lead to compression of nearby nerves, resulting in pain, numbness, or weakness in the limbs.

Symptoms of High-Level Herniated Discs
In your case, the symptoms you describe—pain in the left lower back, buttock, and occasionally radiating down the leg—are common indicators of a herniated disc. The fact that you experience increased pain when bending backward suggests that the herniated disc may be pressing on the spinal nerves or the spinal cord itself. This is particularly concerning given the location of your herniation at T12-L1 and L1-L2, which is relatively high for lumbar disc issues.

The symptoms you experience, such as the inability to lift your leg fully and the sensation of electric shocks, are indicative of nerve involvement. The pain that worsens with certain movements (like backward bending) and improves with others (like forward bending) is also a classic sign of disc-related issues.

Treatment Options
1. Conservative Management:
- Physical Therapy: You mentioned undergoing physical therapy, which is often the first line of treatment. This can include modalities such as heat therapy, electrical stimulation, and specific exercises aimed at strengthening the core and stabilizing the spine. It’s crucial to continue with these exercises, even if it feels like progress is slow. Consistency is key.

- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If over-the-counter options are insufficient, your doctor may prescribe stronger medications.

2. Advanced Therapies:
- Corticosteroid Injections: If conservative management fails, epidural steroid injections can provide relief by reducing inflammation around the affected nerves.

- PRP (Platelet-Rich Plasma) Therapy: While you mentioned concerns about PRP being a temporary solution, it can promote healing in the affected area and may be worth discussing with your physician.

3. Surgical Options:
- If symptoms persist despite conservative treatment, surgical options such as discectomy (removal of the herniated portion of the disc) or spinal fusion may be considered. Surgery is typically reserved for cases where there is significant nerve compression leading to weakness or loss of function.

Why Muscles Feel Tight
The sensation of tightness in your muscles, especially after activity, can be attributed to several factors:
- Muscle Guarding: Your body may be subconsciously tightening muscles around the affected area as a protective mechanism against pain.

- Inactivity: Prolonged sitting or inactivity can lead to muscle stiffness. Regular movement and stretching are essential to maintain flexibility.

- Nerve Irritation: If the nerves are irritated due to the herniated disc, this can lead to muscle spasms and tightness.

Moving Forward
To improve your condition, consider the following:
- Continue Physical Therapy: Work closely with your physical therapist to ensure you are performing the right exercises and not exacerbating your condition.

- Core Strengthening: Once you have managed the pain, focus on strengthening your core muscles, which support the spine.

- Regular Activity: Incorporate low-impact activities like walking or swimming to keep your body moving without putting too much strain on your back.

- Consultation: If you feel stagnant in your recovery, seek a second opinion from a spine specialist who may offer different insights or treatment options.

In conclusion, managing a high-level herniated disc requires a multifaceted approach that includes conservative treatment, lifestyle modifications, and possibly advanced therapies. It’s essential to remain proactive in your treatment and maintain open communication with your healthcare providers to find the best path forward for your recovery.

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