L5-S1 herniation, L5-S1 LUMBOSACRAL JOINT OF SPINE COLUMN

L5-S1 LUMBOSACRAL JOINT OF SPINAL COLUMN

The spinal column on the back is made up of vertebrae. Vertebrae are the 33 individual bones that interlock with each other. The vertebrae are numbered and divided into regions: cervical (there are 7 vertebrae in this region), thoracic (there are 12 vertebrae in this region), lumbar (there are 5 vertebrae in this region), sacrum (there are 5 fused vertebrae in this region), and coccyx (there are 4 fused vertebrae in this region). Only the top 24 vertebrae are moveable; the vertebrae of the sacrum and coccyx are fused.

L5-S1 helps transfer loads from the spine into the pelvis and legs. The L5-S1 motion segment has distinctive anatomy and receives a higher degree of mechanical stress and loads compared to the segments above. These characteristics may make L5-S1 susceptible to traumatic injuries, disc herniation, degeneration, and/or nerve pain.

Conditions affecting the L5-S1 spinal motion segment are usually treated with non-surgical methods. If the lower back and/or leg symptoms worsen or do not improve despite non-surgical treatments, or in case of certain medical emergencies, such as tumors or cauda equina, surgery may be recommended.

NON-SURGICAL & SURGICAL TREATMENTS FOR L5-S1

NON-SURGICAL TREATMENTS FOR L5-S1

  • Medication. Over-the-counter (OTC) medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first for pain stemming from L5-S1. For more severe pain, prescription medication, such as opioids, and/or corticosteroids may be used.
  • Physical therapy. Specific exercises and physical therapies can be designed to target pain stemming from L5-S1. These therapies help stabilize the back and keep the muscles and joints well-conditioned for long-term relief, while also providing a healing environment for the tissues in the lower back.
  • Chiropractic manipulation. Manipulation of the lumbar spine through chiropractic adjustment may help relieve pain stemming from L5-S1.
  • Self-care. Mild to moderate pain may be treated with heat and ice at home. For sciatica pain, it is usually advised to stay active and continue daily activities as tolerated. While bed rest may provide temporary relief from symptoms, it usually does not aid in faster or long-term recovery for sciatica.
  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals. These injections are more effective in treating the inflammatory causes of pain, such as pain from herniated disc fragments.

SURGICAL TREATMENTS FOR L5-S1

  • Microdiscectomy: 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: The facet joints are trimmed to relieve compression of nerve roots.
  • Lumbar interbody fusion: A degenerated disc is removed and L5-S1 vertebrae are fused with implants or bone grafts. https://www.nhs.uk/conditions/lumbar-decompression-surgery/
back pain, L5-S1 herniation, sciatica, slipped disc

CAUSES OF TINGLING FEELING IN UPPER BACK, CAUSES OF TINGLING FEELING IN MIDDLE BACK AND CAUSES OF TINGLING FEELING IN LOWER BACK

A tingling feeling in the back is commonly describes as a pins-and-needles, stinging or “crawling” sensation. Depending on its cause and location, the feeling can be chronic (long term) or short live (acute). Seek immediate medical attention if the tingling is accompanied by (a) sudden weakness in the legs (b) problems in walking and (c) loss of control of bladder or bowel.

TINGLING FEELING IN UPPER BACK

Tingling feeling in upper back is commonly caused by nerve compression, nerve damage or nerve irritation. Some causes include:

  • Cervical radiculopathy. This is a pinched nerve that occurs in the spine within the neck. This occurs when one of the shock-absorbing discs that lies between each vertebra (the bones of the spine) collapses, bulges or herniates, pressing against sensitive nerve. This often happens due to aging or improper body mechanics. Most cases heal with rest, over-the-counter pain relievers and physical therapy. https://cks.nice.org.uk/neck-pain-cervical-radiculopathy
  • Fibromyalgia. This is a disorder of central nervous system that produces widespread muscle pain and fatigue. Pain, ranging from dull and achy to tingling and is often worse in area where there is a lot of movements such as the shoulders and neck. This condition if often treated with pain relievers, anti-inflammatories, muscle relaxers, antidepressants which can help relieve pain and symptoms of depression that occur when living with fibromyalgia. https://www.nhs.uk/conditions/fibromyalgia/
  •  Brachial plexopathy. The brachial plexus is a group of nerves in the spinal column that send signals to the shoulders, arms and hands. If these nerves are stretched or compressed, a stinging, tingling pain can develop. In most cases the pain is felt in the arm briefly. The stinging can radiate around the neck and shoulders. Treatment involves pain medications, steroids to reduce inflammation and physical therapy. https://www.evidence.nhs.uk/search?q=brachial+plexus
  • Lhermitte’s sign. This is a shock-like sensation linked to multiple sclerosis (MS). The pain usually lasts only seconds but can reoccur. There is no specific treatment for Lhermitte’s sign although steroids and pain relievers are common treatments. https://www.mstrust.org.uk/a-z/lhermittes-sign

TINGLING FEELING IN MIDDLE BACK

Tingling feeling in middle back may be caused by shingles. Shingles is an infection caused by the same virus that produces chicken pox (varicella zoster virus). It affects the nerve endings. Once you’ve had chicken pox, the virus can lie dormant in your system for years. If it becomes reactivated, it appears as a blister rash that often wraps around the torso producing a tingling or burning pain. Treatment includes pain relievers, antiviral medications, anticonvulsants, steroids, antidepressants and numbing topical sprays, creams and gels. https://www.nhs.uk/conditions/shingles/

TINGLING FEELING IN LOWER BACK

Tingling feeling in lower back can be due to one of the following:

  • Spinal stenosis. This is a narrowing of the spinal column. This narrowing can trap or pinch nerve roots. Spinal stenosis becomes more common as people age. This condition can be treated with pain relievers, anti-inflammatories, muscle relaxers, steroids. https://www.evidence.nhs.uk/search?q=spinal+stenosis
  • Herniated disc. This can occur anywhere along the spine. However, the lower back is a common place. Treatment consist of rest, ice, pain relievers, physical therapy. https://www.evidence.nhs.uk/search?ps=20&q=slipped+disc
  • Sciatica. The sciatic nerve runs from the lower back into the buttocks and legs. When the nerve is compressed, which can be causes by spinal stenosis or herniated disc or injury on spine, a tingling pain can be felt in your legs. To relieve pain a doctor may prescribe anti-inflammatories, pain killers, muscle relaxers, antidepressants. https://www.nhs.uk/conditions/sciatica/
back pain, L5-S1 herniation

L5 – S1 DISC HERNIATION

Spine is made of 24 movable bones called called vertebrae. There are 5 lumbar vertebrae numbered L1 to L5. The vertebrae are separated by cushion disc which act as shock absobers preventing the vertebrae from rubbing together.https://www.nhs.uk/conditions/slipped-disc/

A herniated disc occurs when the gel-like center of the disc ruptures out through a tear in the though disc wall. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc.

TREATMENTS FOR DISC HERNIATION

Conservative nonsurgical treatment is the first step to recovery and may include rest, medication, physical therapy, home exercises, hydrotherapy, epidural steroid injections, chiropractic manipulation and pain management.

PHYSICAL THERAPY

Physical therapists can advise you on proper posture, lifting and walking techniques and they will work with you to strengthen your lower back, leg and stomach muscles. The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury.https://www.nhs.uk/conditions/physiotherapy/how-it-works/#manual-therapy

EPIDURAL STEROIDS INJECTIONS

The medicine (steroid) is injected next to the painful area to reduce the swelling and inflammation of the nerve. Most patients will notice relief after the epidural injection although the results tend to be temporary. Repeat injections may be given to achieve the full effect.

MEDICATIONS

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and relieve pain
  • Analgesics can relieve pain but don’t have the anti-inflammatory effects like NSAIDs.
  • Muscle relaxants may be prescribed to control muscle spasms.
  • Steroids may be prescribes to reduce the swelling and inflammation of the nerves. They are taken orally in a tampering dosage over few days.

REST

In most cases, pain from a herniated disc will get better within a couple of days and completely resolve in 4 to 6 weeks. Rest, restricting your activity, ice/heat therapy and taking over the counter medications will help your recovery.

If you don’t respond to conservative treatment, your doctor may recommend surgery.

SURGERY

Surgery for herniated disc is called discectomy. This surgery is an option if your symptoms do not significantly improve with conservative treatments. Surgery may also be recommended if you have signs of nerve damage such as weakness or loss of feeling in your legs.

MICROSURGICAL DISCECTOMY

The surgeon makes incision in the middle of your back. To reach the damaged disc the spinal muscles are dissected and moved aside to expose the vertebra. The portion of the ruptured disc that touches your spinal nerve is carefully removed using special instruments.

RECOVERY AFTER DISCECTOMY SURGERY

Recovery time varies depending on the underlying disease and your general health. The original pain may not be completely relieved immediately after surgery. Aim to keep a positive attitude and diligently perform your physical therapy exercises if prescribed.

Most people can return to work within few weeks with jobs that are not physically challenging. Other may need to wait up to 12 weeks, or more, to return to work for jobs that require lifting or operating machinery.

Recurrence of back pain is common. The key to avoid recurrence is prevention. The following guidelines will help prevent recurrence:

  • proper lifting
  • good posture when sitting, standing, moving and sleeping
  •  appropriate exercise program
  • an ergonomic work out
  •  healthy weight and lean body mass
  • a positive attitude and relaxation techniques (e.g. stress management)
  • no smoking