Discectomy, Epidural Steroid Injections, L4-L5 herniation

SLIPPED DISC AT L4-L5, SYMPTOMS AND TREATMENT

COMMON SYMPTOMS AND SIGNS OF L4-L5 SLIPPED DISC

Depending on the type and severity of the underlying cause, the L4-L5 slipped disc may cause lumbar radicular pain of the L4 and/or L5 spinal nerves, also called sciatica. Common symptoms and signs include:

  • Sharp pain, typically felt as a shooting and/or burning feeling that originates in the lower back and travels down the leg in the distribution of a specific nerve, sometimes affecting the foot.
  • Numbness in different parts of the thigh, leg, foot, and/or toes.
  • Weakness while moving the thigh, knee, or foot in different directions.
  • Abnormal sensations, such as a feeling of pins-and-needles and/or tingling.

TREATMENT FOR L4-L5

Nonsurgical Treatments for L4-L5

  • Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. For more severe pain, opioids, and/or corticosteroids may be used.
  • Physical therapy. Exercise and physical therapy can be modified to specifically target pain stemming from L4-L5 and the lower back. These therapies help stabilise the back and keep the muscles and joints well-conditioned—providing long-term relief.
  • Chiropractic manipulation. Chiropractic adjustment of the lumbar spine may help relieve pain stemming from the L4-L5.
  • Self-care. To promote healing and/or prevent an L4-L5 injury from becoming worse, a few tips include avoiding:
    • Repeated bending of the spine
    • Sudden, abrupt movements, such as jumping
    • High-intensity exercise and lifting heavy weights

Injection Treatments for L4-L5

  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibres to pain, generating fewer pain signals.
  • Radio-frequency ablation. Radio-frequency ablation may be used to treat pain from the L4-L5 vertebral facet joints.

Surgical Treatments for L4-L5

  • Microdiscectomy. In this surgery, a small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
  • Laminectomy. A part or all of the lamina (area of bone at the back of the vertebra) is removed to provide more room for the cauda equina.
  • Foraminotomy. The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving the compression.
  • Facetectomy. Nerve root compression is relieved by trimming and/or removing a part of the facet joints.
  • Lumbar artificial disc replacement. This surgery is not very common and includes a complete replacement of the intervertebral disc to relieve nerve root compression and replace it with an artificial implant.
  • Fusion of L4-L5. Depending on the extensiveness of the surgery and the amount of bone removed, the surgical segment may be fused with the adjacent motion segment to provide stability. https://www.nhs.uk/conditions/slipped-disc/
Discectomy

WHAT IS DISCECTOMY? HOW SOON CAN YOU TRAVEL BY CAR AFTER DISCECTOMY? HOW SOON CAN YOU RETURN TO EXERCISE AND SPORT? HOW SOON CAN YOU TRAVEL BY PLANE AFTER DISCECTOMY?

Discectomy is a surgery to remove lower back herniated disc that is pressing on a nerve root or the spinal cord. This surgery tends to be done as microdiscectomy, which uses a special microscope to view the disc and nerves. https://www.nhs.uk/conditions/lumbar-decompression-surgery/what-happens/

HOW SOON CAN YOU TRAVEL BY CAR AFTER DISCECTOMY?

When discharged from hospital, generally you go home in a car. It is best to maintain an upright position for your spine whilst getting into the car and throught the journey home. Avoid being in a car for more than 20-30 minutes in the first 6 weeks. Thereafter, you can travel by car as tolerated, but whenever possible, it is advisable to break up long journeys with frequent stops every 30 minutes so that you can get out of the car and walk around.

HOW SOON CAN YOU RETURN TO EXERCISES AND SPORT?

After surgery, you will be seen by the physiotherapist who will advise you on post-surgical activities and exercises. The physiotherapist will aim to help you to gain full range of motion, strength and flexibility to maximize your physical and emotional recovery of surgery. https://www.nhs.uk/conditions/physiotherapy/

Starting exercises after surgery varies depending on your general health, fitness, your preoperative condition and limitations. Listed below is a guide to the appropriate length of time before you may return to sporting activities after discectomy and disc replacement or fusion:

  • Pilates – 8 weeks
  • Yoga – 12 weeks
  • Swimming (Not breast stroke) – 6 weeks
  • Very light gym weights – 8+ weeks (discectomy and disc replacement) & 10 weeks (fusion)
  • Static cycling – 6 – 8 weeks
  • Normal cycling – 12 weeks
  • Tennis, running, badminton, golf and contact sports – 3 months

HOW SOON CAN YOU TRAVEL BY PLANE AFTER DISCECTOMY?

If the journey cannot be avoided, for example, if its an emergency, you can travel immediately wearing hospital stockings. However, whenever possible, avoid short flights travel for 6 weeks and long-haul flights for 12 weeks. This is to minimise the risk of developing deep venous thrombosis and pulmonary embolus, delaying travel by plane by 6 weeks (short flights travel) and 12 weeks (long-haul flights) also decrease low back pain which is particularly worse on sitting after lumbar discectomy and fusion and this travel delay allows initial physiotherapy treatments and advice before traveling.

Whenever possible, have extra leg room while traveling and change position from sitting every 20 – 30 minutes to get up and move around for few minutes. https://www.nhs.uk/conditions/lumbar-decompression-surgery/recovery/