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Spine and Back Health

Extruded Disk

12/14/2010

Question:

I have multi-level degenerative disk disease and an extruded disk at L4. I have numbness/tingling in my left leg along L5 when sitting but minimal or no symptoms when standing. There is no weakness in the leg. It`s been 2 1/2 months and I`m getting impatient waiting for things to improve but have been afraid to do more than walk and the physical therapy exercises.

1. In general how cautious should a person be with an extruded disk regarding activity such as sports (softball, tennis, jogging)? 2. Can the extrusion get worse in this area? 3. Does having one disk rupture increase the risk of another above or below? 4. What can cause pressure on 1 nerve root (L4) and symptoms on another (L5)?

Answer:

Hello, thank you for your question. In general, most herniated lumbar discs improve over about 6-8 weeks, although it certainly can take longer. Overall about 85% will improve without needing surgery. I advise my patients that they should not engage in any exercise more strenuous than walking until their symptoms have been gone for two consecutive weeks. Jogging is never very good for people with back problems -- too much pounding. Disc herniations can get worse, particularly if a person continues to be excessively physically active while they are healing. There's no clear evidence that having a herniated disc increases the risks of an adjacent disc herniating later on. Finally, you have a problem with nomenclature -- there is no such thing as an 'L4 disc'. Presumably, you have a herniation of your L4-5 disc, which can apply pressure to either the L4 or the L5 nerve root depending on where the disc is protruding (centrally vs. laterally). I hope this helps clarify some of these issues.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University