Lumbar Disc Herniation and Its Impact on Nerve Pain

Herniated disc compressing the right leg nerve?

Hello, doctor.
I had a CT scan, and it showed a herniated disc at the fifth lumbar vertebra and the disc below it.
I feel sharp pain in my hips and thighs when bending forward, and the same occurs when leaning backward.
What treatment should I receive? The day before the pain started, I sat and played mahjong for ten hours, and then I felt the pain the next day.
I have a few questions: Is it true that with health insurance, I can only have a CT scan once a year?

A-Hong, 20~29 year old female. Ask Date: 2006/03/07

Dr. Xu Zhenrong reply Rehabilitation

Hello Ah Hong, based on your description, you are experiencing symptoms of nerve root compression due to a herniated disc between the fifth lumbar vertebra and the first sacral vertebra.
This can lead to numbness and pain in the lower back, buttocks, thighs, and the posterior aspect of the calves, sometimes extending to the toes, commonly referred to as sciatica associated with a herniated disc.
Therefore, when bending forward or arching backward, the pressure can exacerbate the symptoms of nerve compression.
Typically, prolonged sitting or standing, repetitive bending, and heavy lifting can also trigger similar symptoms.
The human lumbar spine consists of five vertebrae, and due to their structural differences and load-bearing characteristics, herniated discs are most commonly found between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra.
In terms of clinical differential diagnosis, this includes a thorough orthopedic assessment and imaging studies such as computed tomography (CT) scans and magnetic resonance imaging (MRI), which can reveal disc protrusion or nerve root compression.
Another type of examination is nerve conduction studies and electromyography (EMG), which can also provide valuable information for treatment considerations.
Regarding your question about the CT scan, the decision may need to be made by the attending physician based on clinical symptoms.
As for treatment, the clinical approach during the initial phase of the condition, when pain is significant, is to advise the patient to rest in bed and take non-steroidal anti-inflammatory drugs (NSAIDs).
Once the pain has somewhat alleviated, physical therapy can begin, including heat therapy, lumbar traction, and electrical stimulation, along with gentle joint exercises for the back and legs, and moderate strength training for the abdominal and back muscles to enhance lumbar protection.
Additionally, adjustments in daily life and maintaining proper sitting and standing postures, such as avoiding prolonged sitting or standing and frequent bending or lifting heavy objects, can help relieve pressure on the lower back.
As long as the patient is patient with physical therapy and adheres to therapeutic exercises and proper posture, there is generally a good chance of improvement.
If the above treatments do not yield effective results, consulting an orthopedic surgeon to evaluate the feasibility of surgical intervention may be considered.
Thank you for your inquiry, and I hope this response is helpful to you!

Reply Date: 2006/03/07

More Info

Lumbar disc herniation, commonly referred to as 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 legs. Your symptoms, particularly the sharp pain in the buttocks and thighs when bending forward or leaning backward, are classic signs of nerve involvement due to disc herniation.

The relationship between lumbar disc herniation and nerve pain is significant. When the herniated disc material presses against the spinal nerves, it can cause a condition known as radiculopathy. This condition manifests as pain that radiates along the nerve path, often accompanied by sensations of tingling or numbness. In your case, the prolonged sitting while playing mahjong may have exacerbated the pressure on your lumbar discs, leading to your current symptoms.

In terms of treatment, the approach typically begins conservatively. Here are some common treatment options:
1. Physical Therapy: A physical therapist can design a program tailored to your specific needs, focusing on strengthening the muscles around your spine, improving flexibility, and teaching proper body mechanics to avoid further injury.

2. Medications: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen or naproxen), can help reduce inflammation and alleviate pain. In some cases, your doctor may prescribe stronger medications or muscle relaxants.

3. Epidural Steroid Injections: If conservative treatments do not provide relief, corticosteroid injections can be administered directly into the epidural space around the spinal nerves to reduce inflammation and pain.

4. Surgery: If symptoms persist despite conservative treatment and significantly impact your quality of life, surgical options may be considered. Procedures such as discectomy (removal of the herniated portion of the disc) can relieve nerve pressure.

Regarding your question about the frequency of CT scans covered by health insurance, it varies by plan. In general, many insurance plans may limit the number of imaging studies to prevent unnecessary exposure to radiation and costs. It’s essential to consult with your healthcare provider and insurance company to understand your specific coverage and any necessary pre-authorization requirements.

Additionally, it’s crucial to address lifestyle factors that may contribute to your condition. Prolonged sitting, especially in a position that places stress on the lumbar spine, can exacerbate disc issues. Incorporating regular breaks, stretching, and strengthening exercises into your routine can help mitigate the risk of future episodes.

In summary, lumbar disc herniation can lead to significant nerve pain, and the treatment approach typically begins with conservative measures like physical therapy and medication. If symptoms persist, further interventions may be necessary. Always consult with your healthcare provider to determine the best course of action tailored to your specific situation.

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