An L4-L5 lumbar disc herniation, is the second most frequent spinal pathology after herniated disc L5-S1. Today, with the help of our spine experts, we will fill you in on the symptoms of this pathology and its possible causes.
There are cases in which the pain from an L4-L5 lumbar disc herniation extends to parts of the body where symptoms would not usually appear, and this can sometimes cause confusion when making a diagnosis. We include a discussion of these cases in this article.
To begin with, it is important to know the most common symptoms of an L4-L5 lumbar disc herniation: low back pain, of either intervertebral disc or joint origin, and sciatica pain or radicular pain.
The most common symptoms of a lumbar disc herniation L4-L5
In this section, we give you more details on the most common symptoms usually associated with a lumbar disc herniation in the L4-L5 spine segment. The top most common symptom is sciatica, and it can basically affect the L4-L5 nerve roots. It should be noted that the characteristics of sciatica vary depending on which spinal nerve root is affected.
Symptoms if the affected root is L4:
- Radiating pain: the pain begins in the lower back and radiates down the inner side of the leg to mid-thigh.
- Hypoesthesia: Numbness or loss of sensation on the inner side of your leg and foot.
- Reflexes: The knee jerk reflex may be absent.
- Weakness: The L4 root controls the quadriceps muscle, so if this root is affected, you will have difficulty extending the knee
Symptoms if the affected root is L5:
- Radiating pain: The pain will go down the back of the buttock and thigh and move more towards the front of the leg at the level of the knee, and then continue all the way down to the big toe.
- Hypoesthesia: Loss of sensation in the big toe and the back of the foot.
- Reflexes: in this case no clear change in reflex is observed.
- Weakness: the L5 nerve root controls the movement of lifting (dorsiflexion) the foot, including the toes, so if this nerve root is affected, the patient will have difficulty lifting the foot and may even drag it, a condition known as foot drop. The patient will have difficulty walking on their heels.
In addition to these symptoms, the patient may also feel pain in the lumbar spine and muscle weakness. There are cases in which the person has no symptoms at all and an L4-L5 disc hernia is discovered by chance when the patient has a magnetic resonance image test (MRI) for some other reason.
Less common symptoms
We have treated cases in which a patient complains of pain in the groin, not a common location, but pain can appear here in 20% of cases and be accompanied also by the symptoms mentioned above. But when this pain is the only symptom, it presents an enormous challenge for finding an accurate diagnosis.
Based on the way patients describe it, this groin pain is of the referred type and not radiating pain. By that, we mean that it does not follow the path of any nerve, but is reflected in the groin area, although the origin is in the facet joint L4-L5.
On the other hand, the spinal discs are composed of a gel-like material, called the nucleus pulposus, surrounded by a band of collagen fibers called the fibrous ring that holds in the soft interior disc material. Over time, the collagen fibers break down, weakening the fibrous ring, so in some cases, the contents of the disc escape, producing a herniated disc.
When this happens, there is another kind of pain that rarely occurs, perhaps in 1% of cases: a pain felt deep in the abdominal flank on the same side as the herniated disc L4-L5.
This pain is definitely related to compression of the L5 nerve in patients with a herniated disc or lumbar spinal stenosis. It has been observed specifically in cases with little or no sciatica, and little low back pain.
Causes of L4-L5 disc herniation
One of the main causes of lumbar disc herniation L4-L5 is disc degeneration, which is the result of the gradual, natural, wear and tear related to aging. What does this mean exactly? It means that as you age, your discs lose flexibility and are more likely to tear or break.
On the other hand, you have to be very careful with the way you lift heavy objects from the ground, because if you do this using the muscles of the back instead of those of the legs and thighs, it can trigger a herniated disc. Among the most common mechanical factors that can cause a lumbar disc herniation are the following:
- Repetitive actions or movements
- Poor posture
- Stress from lifting or carrying heavy weights
- On rare occasions, severe injury
- Lack of physical exercise, sedentary lifestyle
In some cases, pain that has a renal or urethral origin may manifest as thoracolumbar pain that radiates to the groin.
Treatment of lumbar disc disease
Is surgery the best treatment option for an L4-L5 lumbar disc herniation? It depends on each case. However, at Instituto Clavel we usually follow a series of graduating steps, beginning with conservative treatments. Conservative treatments, such as those described below, may be enough to relieve the pain that a lumbar disc herniation can cause, and allow you to return to your daily activities.
- Pharmacological treatment: anti-inflammatory medication and analgesics are the most commonly used medications. Muscle relaxants can be an added help to reduce muscle spasms.
- Physical therapy: Massage, stretching, and neuro-reflex therapy are some of the many therapies a physical therapist can use to try to improve symptoms. The exercises that we recommend for lumbar disc herniation L4-L5 are those that involve stretching the gluteal muscles, and core exercises to strengthen the lumbar back muscles.
- Infiltrations: When a nerve root is compressed, it causes an inflammatory reaction that aggravates the pain. Epidural corticosteroid infiltrations can reduce the discomfort by reducing the inflammation.
If the conservative treatments described above are not successful in relieving the patient’s pain, surgery may be considered as a last resort. At Instituto Clavel we opt for minimally-invasive procedures that help the patient recover swiftly. You can find out more in the article referenced here:
Recovery time after surgery for an L4-L5 herniated disc
Categories: Spine treatments, Spine pathologies, Lumbar pain