The L4 and L5 are the two of the lowest vertebrae of the lumbar spine. Combined with the intervertebral discs, joints, nerves, and soft tissues, the L4-L5 spinal motion segment offers a series of features. They support the upper body and allow trunk motion in several directions. As the L4-L5 spinal segment is the load bearer and provides improved flexibility, the L4-L5 motion segment is susceptible to developing pain from injury and/or degenerative changes. Compared to other spinal segments, the L4 and the L5 are more susceptible to damage.
Anatomy of the L4-L5 Spinal Segment
The L4-L5 motion segment includes the following structures:
1. L4 and L5 Vertebrae
Each vertebra consists of a vertebral body in the front and a vertebral arch at the back. The vertebral arch is made up of 3 bony protrusions. The region between the transverse process is called the lamina. The region between the transverse process and the vertebral body is called the pedicle.
The L4 and L5 vertebrae are taller in front than the back. The upper and the lower ends of each vertebral body are covered with bony endplates that help in preventing compressive loads that are placed on the spine.
2. L4-L5 Intervertebral disc
A disc that’s made up of a gel-like material known as nucleus pulposus that’s covered by a thick fibrous ring and is situated between the vertebral bodies of the L4 and L5. This disc provides cushioning and shock-absorbing functions to protect the vertebrae from grinding against each other.
3. L4 Spinal Nerve
The L4 spinal nerve roots come from the spinal cord from a small bony opening on the left and right sides of the spinal canal. These nerve roots join with the other nerves to make up bigger nerves that extend down the spine and travel down your leg.
- The L4 dermatome is an area of the skin that receives sensation through the L4 spinal nerve and it includes parts of your thigh, knee, leg, and foot.
- The L4 myotome is a group of muscles controlled by the L4 spinal nerve and it includes parts of several muscles in the back, pelvis, leg, and foot.
Most Common L4 L5 Pain Symptoms
Disc problems are one of the biggest back issues that people suffer from today. They are also the most painful problems. That’s especially true for the L4-L5 disc area, as it creates painful symptoms that can put hamper your day-to-day life.
1. Chronic Lower Back Pain
Pain in the lumbar region can mean a lot of things. The type of pain you have can help you figure out the problem. Pain can be the first indicator that you have a bulging disc in your L4 L5. You may have some pain in your lower back, near the top of your pelvis. This pain can increase when you press the muscle that’s next to the spine. If you’re constantly feeling pain in your lower back, then you may face problems in doing basic tasks and getting comfortable sleep at night.
2. Leg Pain and or Weakness
Those who suffer from L4 and L5 disc problems can also feel leg pain. It’s one of the most common L4 L5 symptoms. Pain that’s radiating down your leg next to the sciatic nerve can be unpleasant. This constant leg pain can be the reason why someone calls their doctor.
The pain can appear differently in different people, the symptoms may be described as dull, sharp, burning, aching, or stabbing. It can worsen with long periods of sitting, or while sneezing and coughing.
3. Tingling and Numb Feeling
If your disc is pressing on a nerve, then chances are you’ll experience a tingling sensation, numbness, or pins-like feeling in your lower back. The numbness can also be felt in one leg that originates from the button or behind the knee.
If the nerves are affected and pain is in the foot, it’s more than likely that the pain will be felt above your foot or between the big toe and second toe.
Treatment of L4-L5 disc bulge begins with non-surgical procedures. In situations where the back of the leg symptoms aren’t relieved with non-invasive treatments, some surgical methods may be advised by the doctor.
1. Non-Surgical Treatments for L4-L5
- Medication: Prescription and non-prescription drugs can be used to help in relieving pain from L4-L5. Most of the time, doctors suggest nonsteroidal anti-inflammatory drugs for pain relief. For severe pain conditions, opioids, tramadol, or corticosteroids are suggested.
- Physical Therapy: Exercise and physical therapy can be customized to help those who suffer from L4-L5 disc bulging. These therapies help in stabilizing the back and keep the muscles and joints running smoothly.
- Life Style Changes: Significant lifestyle changes can help in healing or preventing L4-L5 injury to become worse. It’s essential to use correct posture while standing, sitting, walking, lying down, and lifting items off the floor to maintain a normal spinal curvature and minimize stress on the spine.
- Ayurvedic Treatment: Another non-surgical treatment for L4-L5 is herbal medicines. Some ayurvedic medicine is well known for providing sciatica treatment and provide relief. It can help in reducing pain and fix the problem from the core.
2. Surgical Treatments for L4-L5
Some doctors may suggest surgical treatment when the symptoms (numbness, weakness, pain) keep worsening even after medications. Lumbar spine surgeries relieve compression of a nerve root and/or the cauda equina. These surgeries include:
- Microdiscectomy: To do this surgery, a small part of the disc material near the nerve root is taken out. To reduce compression, a portion of the bone adjacent to the nerve root may be trimmed.
- Laminectomy: As the name suggests, a part of the Lamina is removed to provide more space for the cauda equina.
- Facetectomy: The opening for the spinal nerve root is enlarged by trimming the bony overgrowth, relieving the compression.
- Lumbar artificial disc replacement: This is the least common surgical treatment for L4-L5 treatment. This surgery includes a complete replacement of the intervertebral disc to relieve nerve root compression and replace it with an artificial implant.