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Herniated lumbar disc. Lumbar disc herniations occur in the back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Here, symptoms can be felt in the lower back, buttocks, thigh, anal/genital region (via the perineal nerve), and may radiate into the foot and/or toe.
Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. [1] Onset may be rapid or gradual. [1] The cause is usually a disc herniation in the lower region of the back. [1] Other causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma.
Lumbar disc disease is the drying out of the spongy interior matrix of an intervertebral disc in the spine. Many physicians and patients use the term lumbar disc disease to encompass several different causes of back pain or sciatica. In this article, the term is used to describe a lumbar herniated disc.
Spinal disc herniation pressing on one of the lumbar or sacral nerve roots is the most frequent cause of sciatica, being present in about 90% of cases. [4] This is particularly true in those under age 50. [13] Disc herniation most often occurs during heavy lifting. [14]
The straight leg raise test is almost always positive in those with disc herniation, [5] and lumbar provocative discography may be useful to identify a specific disc causing pain in those with chronic high levels of low back pain. [47] Therapeutic procedures such as nerve blocks can also be used to determine a specific source of pain. [5]
The anaerobic bacteria can enter the disc through the breach, causing a low virulent and slowly developing infection. Since the disc is an avascular structure, it is an ideal environment for the growth of anaerobic bacteria. Propionibacterium acnes bacteria secrete propionic acid, which can dissolve fatty bone marrow and bone.
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Symptoms may be unilateral or bilateral, and correlate to the region of the spine affected. The most common region for spinal disk disease is at L4–L5 or L5–S1. [20] The risk for lumbar disc disease is increased in overweight individuals because of the increased compressive force on the nucleus pulposus, and is twice as likely to occur in men.
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