L4 L5 Disc Herniation Explained

A herniated disc is one of the most common spinal conditions to affect adults. It occurs when one of the discs located in between the vertebrae becomes damaged. Typically, the jelly-like disc interior pushes through a crack in the tough disc interior and presses on nearby nerves.

The lumbar spine is more flexible and bears more impact than any other area of the spine. So, disc herniation in the L4-L5 spinal level is particularly common. This article will explore L4-L5 disc herniation and how it can be effectively treated. 

What Are the Symptoms of L4-L5 Disc Herniation?

The symptoms of L4-L5 disc herniation are lower back pain, sciatica, back muscle spasms, numbness, weakness, and/or tingling that radiates into the lower extremities. 

Lower Back Pain from L4-L5 Disc Herniation

L4-L5 disc herniation typically causes lower back pain. This pain may be continuous or intermittent, occurring only when a movement or position flares up the affected nerves. 

Pain from an L4-L5 disc herniation may feel sharp and severe, especially when you’re physically active. For some people, this pain improves when they’re seated or lying down. 

Sciatica from L4-L5 Disc Herniation

Sciatica occurs when the sciatic nerve is pinched or compressed. The sciatic nerve extends from the lower back through the buttocks and down the backs of the legs. So, sciatica symptoms affect the lower back and lower extremities. 

L4-L5 disc herniation is a fairly common cause of sciatica. This is because a herniated disc at this level of the spine can press on the sciatic nerve, causing the following symptoms:

  • Pain (often described as a burning or electric shock-like sensation) that radiates from the lower back down one leg
  • Increased pain when sneezing, coughing, bending, or raising your legs while lying down
  • Numbness, usually in parts of the lower back and leg
  • Tingling (formally known as paresthesia) or a “pins and needles” sensation down the path of the sciatic nerve

Symptoms of more severe forms of sciatica include:

  • Weakness in the muscles of the lower back or legs
  • Urinary or bowel incontinence (an inability to control bowel or bladder movements)
    • If you experience incontinence, it’s important to seek emergency medical care to prevent permanent nerve damage

Back Muscle Spasms from L4-L5 Disc Herniation

Some people experience painful lower back spasms with L4-L5 disc herniation. This occurs when the body tries to immobilize the muscles around the herniated disc as a natural protective measure. Unfortunately, this can trigger muscle spasms that are, in some cases, debilitating. 

What Nerve Is Affected by L4-L5 Herniation?

The L5 nerve root is usually affected by L4-L5 disc herniation. 

L5 nerve roots leave the spine through the intervertebral foramen, the small, bony passageways on either side of the spinal canal. The L5 vertebra is the fifth (and lowest) lumbar spine vertebrae. 

Is L4-L5 Herniated Disc Serious?

L4-L5 herniated disc can become serious if it’s left untreated. 

Untreated, an L4-L5 herniated disc can gradually worsen, causing increased lower back pain and neurological symptoms. This may lead to chronic back pain over time, which is associated with a range of health risks, including a decreased quality of life and an increased risk of mental health conditions like depression and anxiety. 

If a herniated disc causes a pinched nerve, the nerve inflammation is likely to become more over time. This can eventually lead to lasting nerve damage, creating the risk of severe health conditions like:

  • Muscle atrophy 
  • Incontinence (loss of bowel or bladder control)
  • Paralysis in one or both legs

With early intervention, herniated discs can often be successfully treated with non-surgical therapies. This is because the earlier the disc is treated, the more effectively your physician and PT can prevent further damage to the spinal tissues. 

Early Signs of L4-L5 Herniated Disc

Understanding the early signs of L4-L5 herniated disc can help you receive treatment for the condition in its initial stages before it becomes severe. Early signs of L4-L5 herniated disc include:

  • Lower back pain, especially while walking, sitting, or sleeping for prolonged periods
  • Lower back pain that shoots into one of the legs
  • Worsened pain when you cough or sneeze
  • Numbness and/or tingling on one side of the body

How Is L4-L5 Herniated Disc Treated?

L4-L5 herniated disc is treated with rest, anti-inflammatory medications, epidural steroid injections, physical therapy, and (in severe cases) surgery.

  • Rest

A short period of rest can help lessen inflammation for an L4-L5 herniated disc. However, avoid prolonged periods of bed rest, which can worsen back pain and neurological symptoms. It’s important to remain active with a herniated disc to prevent stiffness, lost range of motion, and muscle atrophy. 

  • Anti-inflammatory medications

Though they’re not a permanent solution for a herniated disc, anti-inflammatory medications can provide short-term relief for lower back pain and other symptoms. 

  • Epidural steroid injections

Epidural steroid injections involve injecting steroid medication into the epidural space to significantly reduce inflammation and pain. Patients are advised to undergo no more than four injections per year to prevent tissue atrophy. 

  • Physical therapy

A physical therapist can help alleviate herniated disc symptoms by providing exercises that strengthen the core and back muscles, as well as passive treatments (like massage and heat/cold therapy) for pain management. 

  • Surgery for a herniated disc

L4-L5 disc herniation typically only requires surgery if conservative methods have failed to provide relief after several months and the patient’s symptoms are disruptive to their daily activities. A herniated disc may also require surgery if it triggers serious neurological symptoms and poses the risk of permanent nerve damage. 

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The typical surgical approach for a herniated disc is spinal decompression with fusion. Spinal decompression removes the tissue that’s impinging on the nerve, while fusion stabilizes the spine by permanently fusing the affected vertebrae. 

Unfortunately, spinal fusion can limit the patient’s spinal motion while creating the risk of adjacent segment degeneration. Fusion alternatives like the revolutionary TOPS System can resolve symptoms of spinal stenosis from an L4-L5 herniated disc without compromising your mobility. 

If you’re experiencing symptoms of L4-L5 disc herniation, contact a spinal specialist in your area for a formal diagnosis and treatment plan.