Discectomy, Epidural Steroid Injections, L4-L5 herniation



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.


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/


Below are some of the possible causes of sciatica pain at night:

Attention and Distraction

You may simply be more aware of your pain at night when there is less to distract you from it. This doesn’t mean the pain isn’t real — it is — only that you may be noticing it more at night than you do when you have other things to occupy your mind.

Body Position

When you lay down, the weight of your body may put pressure on your nerves in ways that it doesn’t when you’re upright. This is particularly common with sciatica and other chronic pain caused by pinched or compressed nerves.


Cooler temperatures help many people sleep better. However, cold can also make sciatica pain worse.

Medication Timing and Dosage

The medications that control your pain well during the day may be wearing off too soon at night. You may then need a different dose at night.


Try Sleeping in Different Positions

If your sciatica pain is caused by pinched or compressed nerves, adjusting your sleep position may relieve some of the pressure. For example, people with sciatica who prefer to sleep on their side often find it helpful to sleep with their affected leg on top. People with hip or knee pain may find relief by sleeping with a pillow between their legs.

Adjust the Temperature

Experiment with different room temperatures when you sleep. It may take some time to find the best temperature for you: cool enough to help you sleep, not cold enough to make your pain worse.

Get Appropriate Exercise During the Day

Exercise during the day can help reduce some kinds of chronic pain, and it may help you rest better too.

Practice Good Sleep Habits

While the day’s stimulations may distract you from your pain, they won’t help you sleep. Develop a sleep routine that helps prepare your body for rest. This might include turning off the TV and other screens 1-2 hours before bedtime, reading a book, or taking a warm bath.

Prepare Your Mind for Rest

The stress of chronic pain can make it even harder to rest. Try meditation or deep breathing exercises to lower your stress and help reduce your perception of pain. https://www.nhs.uk/conditions/sciatica/

back pain, treating chronic back pain without surgery


Below are 7 ways to treat chronic back pain without surgery:

(1) Diet
Some diet can trigger inflammation, especially those high in fats, refined sugars and processed foods. Consult your doctor or a dietician about the type of foods that will not trigger inflammation.

(2) Meditation
Chronic back pain is straining emotionally and physically. To manage the frustration, irritability and other psychological aspects of dealing with chronic pain you should consider rehabilitation psychologist who may recommend meditation, yoga and other cognitive and relaxation strategies to keep your mind away from focusing on the pain.

(3) Alternative Treatments
Acupuncture, massage and other nonsurgical spine treatments can make a difference for chronic back pain. Talk to your doctor about alternative treatments that could benefit you.

(4) Lifestyle Modifications
When you have chronic back pain, it is important to accept your limitations and adapt. Take note of the activities that worsen your pain and avoid them if possible. Not only could this help your back feel better, but it could also prevent the underlying condition from advancing.

(5) Injection- based treatments
Epidural steroid injections, nerve blocks and other types of injection-based procedures are available for chronic back pain. They are used when the source of the pain is known and can sometimes help rule out certain causes if the treatment doesn’t work.

(6) Pharmacological treatments
Analgesics, anti-inflammatory drugs, muscle relaxants and other medications can be used to help chronic back pain. However, some come with side effects and are not intended for prolonged use.

Opioids should be prescribed only after a thorough examination by a specialist and if other drugs failed to provide relief. If you find yourself relying on opioids to get through the day, it may be time to seek a second opinion.

(7) Physical Therapy
Exercise may help chronic back pain treatment. The exercises have to be tailored to your specific symptoms and condition. Maintaining a home exercise routine is also part of success. Physical therapy may include: