Bulging disc L5 S1
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The intervertebral disc is a structure that has two principal functions: acting as a connection between adjacent vertebrae while permitting some motion, and providing shock absorption.
The disc is located between two vertebra and looks like a very solid “doughnut” made of an outer fibrous layers (called the 'annulus' which means "ring") while containing a jelly-like substance in the middle (called the 'nucleus').
With age, the intervertebral disc loses water and becomes dried out. As this happens, the disc compresses. This leads to deterioration of the tough outer ring allowing the nucleusto bulge out. This is called a bulging disc.
A ruptured disc means that the disc has been exposed to enough force so that it ruptures through most of the layers of the annulus. The consequence is a leakage of the jelly (nucleus pulposus) past the boundaries of the annulus. As a consequence, the two vertebrae adjacent to the disc aren't bound together and instability and nerve irritation lead to severe back pain.
Pain may be in the low back or may be radicular- meaning it radiates down the leg. The most common cause of radicular pain is herniation of the lumbar disc. The incidence is 1-2% of patients with low back pain (LBP).
85% of herniations occur at L4-5 and L5-S1.
The peak incidence of herniated lumbar disks in adults is between the ages of 30 and 55 years.
The fibrous tissues of the disc are thinnest posteriorly, and that is why disc bulges and herniations occur most often in the posterior direction.
Radicular pain presents with sharp, stabbing radiating pain. Pain is shooting, and increases with physical activity, especially lifting, bending, sitting and exercises that increase intra-abdominal pressure.
Neurologic dysfunction is manifested by motor, reflex, or sensory dysfunction in the lower extremities and rarely as bowel or blader dysfunction.
Sciatica, a sharp or burning pain radiating down the posterior or lateral aspect of the leg (usually to the foot or ankle), is often associated with numbness or paresthesia.
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