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Treatment of the L4-L5 spinal motion segment typically begins with nonsurgical methods. In cases where the back and/or leg symptoms do not improve with nonsurgical treatments, or in case of certain medical emergencies, surgery may be considered.
Nonsurgical Treatment for L4-L5
Nonsurgical treatments of the L4-L5 motion segment include:
Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. For more severe pain, opioids, tramadol, and/or corticosteroids may be used.
Physical therapy. Exercise and physical therapy can be modified to specifically target pain stemming from L4-L5 and the lower back. These therapies help stabilize the back and keep the muscles and joints well-conditioned—providing long-term relief.
Chiropractic manipulation. Chiropractic adjustment of the lumbar spine may help relieve pain stemming from the L4-L5 motion segment.
Self-care. To promote healing and/or prevent an L4-L5 injury from becoming worse, a few tips include avoiding:
Repeated bending of the spine
Sudden, abrupt movements, such as jumping
High-intensity exercise and lifting heavy weights
It is important to use correct posture while standing, sitting, walking, lying down, and lifting items off the floor to maintain a normal spinal curvature and minimize stresses on the spine.
Injection Treatments for L4-L5
Different types of injection treatments can help reduce inflammation and/or stop the L4-L5 pain impulses from reaching the brain.
Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals. These injections are more effective in treating the inflammatory causes of pain, such as pain from herniated disc fragments, and are typically less effective for compressive causes of pain.
Radiofrequency ablation. Radiofrequency ablation may be used to treat pain stemming from the L4-L5 vertebral facet joints. A part of the pain-transmitting nerve is heated with a radiofrequency needle to create a heat lesion. This resulting lesion prevents the nerve from sending pain signals to the brain.
While performing injection treatments, fluoroscopic (x-ray) guidance with radiopaque contrast dye is usually used for correct needle placement. Fluoroscopic guidance helps improve the diagnostic accuracy and decreases procedural risks.
Surgical Treatments for L4-L5
Surgery may be considered when the neurological deficits, such as numbness and/or weakness continue to worsen despite several weeks of nonsurgical treatments. For a successful surgical outcome, a structural condition that is known to be responsive to surgical treatment must be present. Surgery may also be advised in cases of tumors or infections. Lumbar spine surgeries to relieve compression of a nerve root and/or the cauda equina are usually performed using minimally invasive techniques and include:
Microdiscectomy. In this surgery, a small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
Laminectomy. A part or all of the lamina (area of bone at the back of the vertebra) is removed in order to provide more room for the cauda equine.
Foraminotomy. The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving compression.
Facetectomy. Nerve root compression is relieved by trimming and/or removing a part of the +0.facet joints.
Lumbar artificial disc replacement. This surgery is not very common and includes a complete replacement of the intervertebral disc to relieve nerve root compression and replace it with an artificial implant.
Fusion of L4-L5. Depending on the extensiveness of the surgery and the amount of bone removed, the surgical segment may be fused with the adjacent motion segment to provide stability.
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It will take about 4 to 6 weeks for you to reach your expected level of mobility and function. When you wake up after lumbar decompression surgery, your back may feel sore and you'll probably be attached to 1 or more tubes.
For mild herniated disc pain, relieve the inflammation to decrease pain. For instance, applying a heating pad or ice pack to the affected area may be a good way to temporarily relieve your pain and reduce inflammation. Take 10-15 minutes twice a day to lie on your stomach with one to two pillows under your hips.
Common injection treatments for L5-S1 include: Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals.
People with ongoing or recurrent episodes of lower back pain should consider the benefits of walking as a low-impact form of exercise. Aerobic exercise has long been shown to reduce the incidence of low back pain.
It will take about 4 to 6 weeks for you to reach your expected level of mobility and function (this will depend on the severity of your condition and symptoms before the operation). When you wake up after lumbar decompression surgery, your back may feel sore and you'll probably be attached to 1 or more tubes.
After surgery, you can expect your back to feel stiff and sore. You may have trouble sitting or standing in one position for very long and may need pain medicine in the weeks after your surgery. It may take 4 to 6 weeks to get back to doing simple activities, such as light housework.
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