The L4-L5 Disc Bulge & Disc Herniation
Herniated and bulging disc at the lower back is most common at the L4-L5 segment or level. The L4-L5 is situated at your belt line. It is responsible for 95% of bending and twisting motions involving the waist. Moreover, it the most heavily burdened spinal segment, as they provide load-bearing functions that support the upper body. Due to the excessive stress placed on it, the L4-L5 section is a common site for spinal disc bulges, herniations, protrusions, prolapses, extrusion, and fragmentations. This article will provide in-depth information on the L4-L5 spinal segment to help you understand your condition and what you can do to recover fully without surgery or injections.
The L4-L5 spinal segment is a common cause of acute and chronic lower back pain. An L4-L5 disc bulge can impinge nerves that run down the legs, causing sciatic-like symptoms. A slipped disc is one of the most common causes of a pinched nerve. An L4-L5 disc bulge or slip-disc (slipped disc) pinches and leads to serious health issues, including impotence, reproduction issues, infertility, loss of bowel and bladder control, or paralysis in one or both legs. A pinched nerve at the L4-L5 level can also occur from bone-spurs (spondylosis) or ligament thickened (hypertrophy of ligamentum flavum).
This article provides in-depth information on the L4-L5 segments and the common conditions that arise from them. Regardless of the cause, an L4-L5 spinal segment is treatable without surgery or injection. The key to recovery is accurate diagnosis followed by corrective treatments that focus on the problem’s root cause. Let’s start with some general information on the low back (lumbar spine) before we start on disorders and treatment options.
The Function Of The Lumbar Spine
The lumbar spine is also referred to as the lower back. It is a complex structure. There are a total of 5 vertebral bones in the lumbar spine. Each attached to an intervertebral: working closely with surrounding muscles, joints, and nerves to provide a dynamic range of movements and weight-bearing. The L4-L5 spinal disc is the second-lowest disc space, and the lowest segment is the L5-S1. The L4-L5 spinal segment is the most critical of all the lower back segments as it accounts for 95% of bending at the waist. It is no accident that most back pain patients present with L4-L5 disc bulge disorders.
It also has a higher chance of undergoing degenerative changes and eventual disc herniation (slip disc or slipped disc). A herniated disc is the leading cause of spinal canal stenosis and disability. Let our expert clinical non-surgical teams provide you with the exceptional care you need today.
How The Spinal Disc Gets Damaged?
Intervertebral discs are made up of two essential parts, the annulus fibrosis on the outer rim and the nucleus pulposus in the inner portion. However, repetitive trauma, constant axial loading of the spine, injury, or weakness of the lower back muscles can cause the inner part (nucleus pulposus) to protrude through the outer ring. This can result in different types of slipped disc, such as disc bulge, disc herniation, prolapsed disc, or sequestrated disc, extruded discs, and fragmented disc.
A slipped disc can causes impingement on the exiting nerve root or nerve roots. In severe cases, an L4 disc herniation can impinge multiple traversing nerve roots: L5 and even the S1 nerve root. In other words, one slip disc can pinch several nerve roots and even the spinal cord. Nerve root impingement and compression of the spinal cord are the main reasons why so many opt for L4-L5 surgery. However, before we provide information on an L4-L5 operation or other forms of spine surgery or lumbar fusion, we like to go over some of the common symptoms associated with an L4-L5 nerve root impingement.
Common Problems Involving The L4-L5 Spinal Segments
To help you understand the cause of your low back pain, we have listed some of the most common disorders that involve the L4-L5 spinal segments include:
- Muscular and ligamentous disorders
- Disorders of the spinal joint or facet joints
- Slipped disc (slip-disc)
- Spinal canal stenosis
- Foraminal stenosis
Muscle & Ligament Disorders At L4-L5
Muscular and ligamentous issues involving the L4-L5 segments are relatively common. They are present in almost all persons over the age of 40. However, having muscles or ligament issues alone will not cause significant pain. A muscular or ligamentous source of back pain occurs when they are damaged. Injury, damage, or disorders of the ligamentum flavum are common muscular and ligamentous issues that cause concern. Ligamentum flavum is a ligament with muscle characteristics. In other words, it has contractile abilities. Damage to ligamentum flavum leads to hypertrophy of ligamentum flavum that compress the nerve and spinal cord.
Spinal Joint Disorders
As mentioned, the L4-L5 spinal segment is the most mobile and most burdened in the lower back. Moreover, the weight-bearing activities during sitting put excessive burdens on these segments’ joints. Spinal joints or facet joints of the spine are lined with cartilage that contains synovial membranes. Stress during standing or sitting can lead to inflammatory changes where fluids accumulate within the joints. Excessive accumulation of fluids is the leading factor in joint degeneration (facet hypertrophy) and bone spurs (arthritis).
L4-L5 Slip-Disc (Slipped Disc)
Bulging, herniated, protruded, and prolapsed discs are medical terms that imply a slip-disc or slipped disc—an L4-L5 slip-disc results when the spinal disc at L4-L5 degenerate or wear out. The most common site for spinal disc degeneration, disc bulge, and the slipped disc is the L4-L5 segment. AN L4-L5 slip disc (herniated or bulged) can impinge (compress) the thecal sac (spinal cord fibers) and spinal nerves. The slightest amount of compression or impingement on a nerve or spinal cord fibers is significant. Nerve compression is significant because it causes nerve degeneration. The degenerative changes within a nerve are the leading reason for weakness and paralysis.
A compressed nerve can result from a slipped disc, bone-spur, spinal misalignment (subluxations), spondylolisthesis, and ligamentous issues (hypertrophy of ligamentum flavum). Bone-spurs (arthritis and spondylosis) are the second most common cause of a compressed nerve. Regardless of the cause, compressed nerves need urgent attention, especially at the L4-L5 segment of the lower back.
Spondylolisthesis At L4-L5
An L4-L5 spondylolisthesis is a congenital or, at times, an acquired condition (degenerative spondylolisthesis) where one vertebra slips forward to the vertebrae below. The slippage of one vertebra on the other (spondylolisthesis) is graded based on its severity.:
- A grade I spondylolisthesis: forward slippage of less than 24%
- Grade II spondylolisthesis: Slippage of 25-49%
- Grade III spondylolisthesis: Slippage of 50-74%
- And A Grade IV spondylolisthesis: slippage of over 75%
Spondylolisthesis is always present with co-condition. The most common co-conditions associated with spondylolisthesis are:
- Hypertrophy of ligamentum flavum: Thickening of a spinal ligament within the canal
- Facet Hypertrophy: Bone spurs and arthritis
- Disc Degeneration: Wear and tear of spinal discs
- Joint Degeneration: Wear and tear of spinal joints
- Spinal canal stenosis: Shrinkage in the spinal canal size
- Foraminal Stenosis: Shrinkage of the holes where spinal nerves come out
As you can see, spondylolisthesis can become quite a problem. Spondylolisthesis at the L4-L5 spinal segment can cause carrying degrees of back pain, leg pain, and sciatica. It may also cause weakness in the legs, loss of bowels and bladder control, reproductive issues, and paralysis. Both degenerative and the acquired forms of spondylolisthesis are treatable without surgery.
What Is An L4-L5 Spondylosis?
Spondylosis is a relatively loose term describing a combination of the spinal disc and spinal joint disorders leading to nerve root irritation. The L4-L5 segment is a common site of spondylosis. Symptoms of spondylosis at the L4-L5 vary. Symptoms depend on the severity of nerve compression resulting from the spondylosis. However, having no pain does not mean that you have no spondylosis. For most, spondylosis is asymptomatic (cause o pain) until later stages. We have provided common symptoms often seen with varying degrees of spondylosis at L4-L5 below:
- Mild L4-L5 spondylosis causes back pain.
- Moderate L4-L5 spondylosis cause back pain, pain in the buttocks, hips, thighs, leg, or feet. It may also cause numbness, tingling, or weakness in the leg, feet, or toes.
- Severe L4-L5 spondylosis causes intense back pain, weakness in legs, bladder and bowel disorders, erectile dysfunction in males, and female reproductive issues. If neglected, it will lead to partial or complete paralysis.
What Are The Dangers Of An Canal Stenosis At The L4-L5 Level?
Spinal stenosis is a common cause of pain and disability. The L4-L5 level is the most common site for spinal canal stenosis in the lower back. Spinal stenosis results from premature wear and tear of spinal joints, muscles, ligaments, and spinal discs. The shrinkage or stenosis of the spinal canal is a progressive disorder. What this means is once the shrinkage starts, it progresses. The danger with progression is complete or partial impairment of nerves or spinal cord. Any reduction of the spinal canal is a cause for concern, especially if the reduction is at the L4-L5 level. They concern us because it leads to weakness or paralysis of lower limbs, impotence, infertility, and loss of bowel and bladder control— Common sites of spinal canal stenosis.
L4-L5 Foraminal Stenosis
Canal stenosis refers to shrinkage of the spinal canal (housing of the spinal cord). Foraminal stenosis refers to the narrowing of the opening between spinal segments. The opening (foramina) shrinks with spinal disc degeneration, joint degeneration (facet hypertrophy), ligamentous issues (ligamentum flavum hypertrophy), or bone spurs (arthritis). Foraminal stenosis at L4-L5 is the leading cause of back pain, sciatica, leg pain, numbness, and weakness in the legs.
Symptoms Of Lumbar Spinal Segment (L4-L5)
Most patients may experience lower back pain that radiates to one side of the lower limb, or sometimes even both sides. Tingling, numbness (pins and needles), and an aching or burning sensation in the leg and on top of the foot are widespread. In severe cases, an L4-L5 slipped disc leads to weakness in the legs or feet. Some may even have an inability to walk, leading to an inability to stand. Those who cannot walk or stand may have a condition called “foot drop.”
In patients with footdrop frequently present with a high steppage gait where they exaggeratedly raise the thigh while walking as if they are climbing the stairs. They also have a slapping gate, where the foot strikes the ground as they walk. A drop foot is a severe condition resulting in damage or degenerative changes in the nerves that control leg and foot movements. The degree of injury is relative to the severity of a slipped disc. Therefore, those with a slipped disc should do their utmost best to obtain the needed non-surgical care as soon as possible. While surgeons recommend surgery for foot drop, we recommend our conservative treatment through collaborative chiropractic and physical therapy (physiotherapy).
What Are The Best Treatment Options For L4-L5?
Of course, the best option is a non-surgical route. Acute lower back pain or chronic lower back pain treatment is always better with nonsurgical treatments as provided by our comprehensive methods. The best of the targeted, extensive measures for lumbar discs of acute or chronic nature are integrative chiropractic, physical therapy, and physiotherapy methods.
Chiropractic Specialty Center® offers combined treatments from clinical and experts teams of chiropractors and physiotherapists. The care you will get from our chiro-zone will include spinal adjustments and flexion-distraction therapy. Our physio-zone provides focused L4L5 physiotherapy through manual or highly specialized machines. Therapy devices such as spinal decompression therapy, shockwave therapy, high-intensity laser therapy are among some of what you will get at our physio-zone.
Chiropractic treatment of the L4-L5 or L5-S1 consists of the realigning of malpositioning spinal segments, stabilizing joints, and depressurizations of spinal discs. The best and most effective treatment for L4-L5 slipped disc is through a non-rotatory method of chiropractic. Rotatory chiropractic adjustments such as Gonstead or Diversified can further damage a slipped disc. As such, our chiropractors provide treatments through an Activator. The Activator is the best and most targeted means of chiropractic treatment for acute lower back pain or chronic lower back pain.
L4-L5 Treatment At Our Chiro-Zone & Physio-Zone
our chiro and physio-zones provide precision treatment and therapies for the L4-L5 that are impossible at competing centers. Our methodology and technology for the L4-L5 segments enable our clinical teams to provide you efficacious non-invasive therapies that fix and repair the actual cause of an L4-L5 problem. Best of all, the care you get is holistic and natural without any side effects.
Physical therapy (physiotherapy) involves manual procedures provided by physical therapists or physiotherapists. Manual methods such as joint mobilizations, soft tissue mobilizations, and strengthening programs are integral to physical therapy treatment at our physio-zone. Physiotherapy is the process of providing treatments through therapeutic devices specific to the spine. In our centers, our patients receive both physical therapy and physiotherapy. We provide targeted spinal rehabilitation at our physio and chiro-zones in addition to physiotherapy and physical therapy treatments.
Our combined collective and collaborative nonsurgical treatments incorporate the best principles of lumbar disc treatments as provided through chiropractic, physical therapy (physiotherapy), and breakthrough devices (the RxDecom®) through the NSD Therapy® protocols. To summarize, NSD Therapy® is the gold standard in conservative treatments for acute or chronic lower back pain.
Can Pressure On The Nerves From A Slipped Disc Be Relieved Through Non-Surgical Treatments?
The L4-L5 Lumbar disc often places varying degrees of pressure on the nerves when they bulge, herniate or protrude. In other words, a slipped disc or slip-disc can impinge or put significant amounts of pressure on the nerves that exit the spine. Spine surgeons often attempt at either destroying the nerve through a Radiofrequency Ablation (RF Neurotomy) or other forms of spine surgery to alleviate the pressure on the nerves. However, surgical interventions have not proven well in the long term. Sufferers who sought surgical interventions for an L4-L5 disc often return for additional surgeries.
Pressure on the nerves from herniated, bulging, or extruded lumbar discs are best treated without surgery. In our center, our primary goal is to take away the pressure on the nerves by correcting issues that led to nerve impingements or nerve pressure (pinched nerves). Our non-surgical treatments for the L4-L5 are not patches that spine surgeons offer. They are to fix the damaged joints, muscles, ligaments, and lumbar discs through our nonsurgical treatments.
Should You Opt For L4-L5 Spine Surgery?
L4-L5 lumbar fusion or minimally invasive spine surgery is not as effective as some would have you believe. Spine surgery is just that: surgery! So, when they use terms such as the “minimally invasive spine surgery,” they decrease your surgical fears by making it sound minimalistic. In other words, it is a play-on-words. Ye, it is not as intense as fusion surgery (lumbar fusion), bone graft, discectomy, foraminotomy, or laminectomy, but it is invasive. Even the most minimally invasive spine surgery carries risks and, as such, is better avoided, especially when effective conservative measures are available right here in town. It is just that simple!
We are even opposed to an l4-L5 spinal injection, such as steroidal injections at the L4-L5. Steroidal injections or any other type of injection into the spine have complications. Besides, under the best scenarios, spinal injection only provides limited improvement. But, the failure rate and risks of complications are even higher when it comes to spine surgery. Steroidal injections, facet joint injections, and spine surgery are invasive means that offer short-term gains. Our advice is to opt for nonsurgical treatments from our clinical experts.
The L4-L5 spine surgery, like the steroidal injections, is a temporary solution, often requiring additional surgical interventions. So, they are not the fix; some would have you believe. If you have a lumbar spine condition for which the surgeons recommend surgery, call our center. Visit our clinical research-based teams for effective chiropractic and physiotherapy (physical therapy) options enhanced with spine-specific technology. We have helped thousands of patients that the surgeons recommended lumbar surgical intervention. We are confident that our non-surgical treatments will provide you with better options when compared to an L4-L5 surgery.
The Best Non-Surgical Treatments For L4-L5 Spinal Discs & Joints
If you seek the best conservative treatment options for an L4-L5, visit our center and receive targeted nonsurgical treatments today. Our clinical teams have the most comprehensive treatment programs for mechanical spine conditions, including slipped disc, facet joints, and spinal nerve damage. Best of all, the care you get from us will help you avoid the necessary spine surgery or spinal injections. Spine surgeons dedicate their time and energy to invasive procedures while concentrating on non-surgical options. So, if you are looking for non-surgical fixes or repairs, we are the better options. Your surgeon is an expert in spine surgery and may not be familiar with the latest non-surgical intervention trends. That could be the reason why they are so adamant about having you go through spine surgery.
As far as we are concerned, the L4-L5 surgery is an option best avoided. We have been treating many severe lower back cases, such as a slipped disc, with a higher than 90% success rate. In short, almost every patient we have treated has improved. If you or any of your friends are experiencing similar symptoms, please do not hesitate to give us a call today! Centers have provided non-invasive treatment for the L4-L5 slipped disc through the efforts of the best research-based chiropractors in Malaysia, advanced clinical physiotherapists, and specific methods and technology-specific for a slipped disc. If you have an L4-L5 slipped disc, we are your best bet for a speedy recovery. Our methods and technology have helped thousands. Visit one of our centers for the best L4-L5 treatment without surgery or injection today.