This condition is known as Herniated Nucleus Pulpous (HNP). Degenerated disc weakens the outer layer of the disc which is called Annulus Fibrous. The inner jelly-like core is called the Nucleus Pulposus. With progressive degeneration, the nucleus Pulposus leaks out, depleting the disc of its nutrients. This concept is known as herniated disc or disc herniation.
Sciatica occurs as a result of nerve compression from the herniated disc. This condition causes pain from direct pressure on the nerve which mostly affects the back, buttock and radiated pain in the legs. The leg pain is referred to as radiculapathy. The lumbar and sacral regions of the spine are more prone to disc herniation which give rise to approximately 90% of Nucleus Palposus. The most common discs include L4-L5, resulting in pain in L5 or S1 nerves respectively. With progression of Nucleus Palsosus leakage, pain intensifies in the back and leg. Sometimes patients experience dysthesias and anesthesias with severe HNP.
Herniation occurs at various degrees. The mildest form of disc hernaition is disc bulging. This is associated with mild pain and does not require any intervention. Non-surgical treatment is offered for moderate to severe herniation. These include Non steroidal Anti-inflammatory (NSAID) and physical therapy. Facet and steroidal injections are used to treat pain from caused from Herniated disc.
Non-operative treatment is delivered for a maximum of six weeks, after which surgical intervention of Discectomy is considered if the initial approach was unsuccessful. With Discectomy, the herniated portion of the disrupted disc is surgically removed which has a high success rate. Post surgical recommendation includes lifestyle modification. This is required to eliminate pain. However, long term pain relief is not guaranteed. Urgent surgical intervention is required for a severe form of disc herniation called Cauda Equina Syndrome. This cause severe bilateral leg pain, loss of sensation in the perianal region, bladder paralysis and weakened anal sphincter.