Spinal Health and Herniation: A Closer Look at Back Pain Origins

A disc usually herniates toward the back and to the side – where the nerve root lies. For this reason, the majority of herniations pose a risk of impacting the nerve root at that specific spinal level.

For example, a herniation at the L5-S1 spinal segment most likely affects the L5 nerve root, which exits the spinal canal at the L5-S1 segment. However, the L5 nerve root can be less commonly affected by disc herniations at L2-L3, L3-L4, or L4-L5.

Specific symptoms of a lumbar disc herniation based on the spinal segment affected are listed below:

L1-L2 disc affecting the L1 spinal nerve root:

Pain and sensory loss in the groin (inguinal region)

Weakness in the hip muscles occurs in rare cases

L2-L3 and L3-L4 discs affecting the L2 and L3 spinal nerve roots:

Pain in the lower back, front of the thigh, knee, and/or long the inner side of the leg and foot

Pain is worsened by sneezing, coughing, or straightening the leg

L4-L5 disc affecting the L4 spinal nerve root:

Pain in the lower back, front of the thigh, and the inner side of the leg.

Weakness in the hip and knee muscles causes difficulty with lifting the leg, crossing the legs, or straightening the leg.

L5-S1 disc affecting the L5 nerve root:

Pain in the lower back, buttocks, outer sides of the thigh and calf, top of the foot, and the big toe

Numbness in the calf, top of the foot, and the web space between the first and second toe

Weakness in the hip, knee, foot, and big toe muscles causing difficulty with bending and straightening the leg or moving the foot in different directions

Inability to lift the foot off the ground (foot drop)

S1-S2 disc affecting the S1 spinal nerve root:

Pain in the buttock radiating to the back and side of the thigh and calf, bottom of the foot

Numbness in the calf and along the side or bottom of the foot

Weakness in the hip, knee, and foot muscles causing difficulty or an inability to walk on the toes

Bowel and bladder dysfunction and/or sexual dysfunction occur in serious cases

It is also possible for more than one nerve root to be affected and cause overlapping symptoms. The symptoms may also be affected by normal variations in the patient's lumbar spine anatomy, perception of pain, and other factors.

In rare cases, compression of the spinal cord (myelopathy) may occur with a herniated disc at L1-L2 or in patients with a low-lying spinal cord, or compression of the cauda equina (cauda equina syndrome) may occur with a herniated disc between the L2-S1 spinal levels.

Conditions That Mimic Lumbar Herniated Disc Symptoms

Some conditions mimic the symptoms and signs of a lumbar herniated disc, including:

Piriformis syndrome is a condition where the piriformis muscle located deep in the buttock becomes inflamed and spasms, irritating the sciatic nerve. The symptoms may include buttock pain and/or nerve pain that travels along the sciatic nerve down the thigh and leg.

Sacroiliac (SI) joint dysfunction: a condition where the SI joint – situated on both sides of the sacrum at the base of the spine – moves too much or too little, causing pain in the buttock, lower back, and leg.

Tarsal tunnel syndrome: dysfunction of the tibial nerve in the inner ankle. This condition causes sharp shooting pain in the ankle area and along the sole of the foot.

Accurate diagnosis is critical for effectively treating these conditions or a herniated disc.

Enhance Your Knowledge

If you're interested in furthering your understanding of orthopedic issues and anatomy, consider exploring the educational courses available at ANF Academy . Discover more about how your body works and learn ways to maintain your orthopedic health effectively.

Resources:

https://orthoinfo.aaos.org/