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/