Orthopedics-Online

Herniated disc of L3 / L4

What is a herniated disc L3 / L4?

A herniated disc is a disease of the spine. Disc material emerges from the disc into the spinal canal. Nerves can be irritated or even injured.

L3 and L4 describe the height of the herniation and is a very common location for a herniated disc. The herniated disc is at the level of the lumbar spine, precisely at the same level as the topmost point of the iliac crest. A herniated disc mainly affects people between the ages of 30 and 50.

You can read more interesting information on this topic under: Herniated disc of the lumbar spine

These symptoms indicate a herniated disc of L3 / L4

Pain is part of every herniated disc. The pain can be acute (up to 6 weeks), subacute (6-12 weeks) or permanent (over 12 weeks) occur. Usually the pain has a stabbing quality. Those affected also describe shooting pain, which can then radiate into the legs.

In addition to the pain, abnormal sensations can be noticed. These include feelings of tingling or numbness. In serious incidents, muscle paralysis - primarily in the thighs - can occur. The reflexes, for example on the knee, may also be reduced.

Are you interested in this topic? Read more about this under: Symptoms of a herniated disc of the lumbar spine

That's when the pain occurs

With a herniated disc at the level of L3 / L4, the pain occurs in the lower back, which is also called Lumbar pain referred to as. The pain is sharp and also restricts movement in the lower back. The radiation of pain pulls into the legs.

In the event of an incident at the L3 / L4 level, the femoral nerve is irritated. The pain can therefore be felt along the path of the affected nerve.

In L3 syndrome, the pain moves to the front of the thigh and knee, but never below the knee. In L4 syndrome, pain extends from the outside of the thigh over the kneecap to the inside of the lower leg and the front edge of the shin.

Read more about this topic under: Pain in the intervertebral disc

Appointment with a specialist for a herniated disc?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

A herniated disc is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

Therefore, treating a herniated disc requires a lot of experience.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

Tingling vs. Numbness in the leg

Tingling and numbness are signs that nerves are irritated, pinched, or injured. The tingling sensation is often also referred to as ant walking. The tingling or numbness occurs in the supply area of the affected nerve.

In the L3 / L4 syndrome, the sensory disturbances can be felt on the front of the thighs and partly on the inside of the lower leg, analogous to the pain sensation. If sensory disturbances occur, a doctor must be consulted urgently in order to prevent permanent damage to the nerves.

You can read the next article on this subject below: Herniated Disc - Symptoms in the Leg

Paralysis in a herniated disc

Paralysis can occur with a herniated disc. This then affects the identification muscles of the spinal cord roots L3 / L4. This can lead to a limited extension of the thigh in the knee joint, a reduced bringing one leg to the other and a weakened hip flexion.

Since the muscles are in most cases supplied by several nerve roots, for the most part there is no complete paralysis, but only a weakening of the muscle function. A doctor should also be consulted in the event of functional impairment or paralysis of the muscles.

Therapy of a herniated disc of L3 / L4

The aim of the therapy is to eliminate the symptoms and - if necessary - to reintegrate into social and professional life. Various therapies are available for this:

Early therapy with painkillers,
Injecting local anesthetics in the area of the affected nerve root,
Physical therapy (Physiotherapy, massage, heat therapy),
Exercise therapy (no bed rest, but carry on daily activities, longer walks),
Patient education (Changes in behavior, sport, back training) and
operative therapies (microsurgical or open).

You can read more helpful information on this here: Therapy of a herniated disc of the lumbar spine

Medication

In the case of a herniated disc, medication is primarily used to reduce pain. Here, painkillers are used according to a certain level scheme. So-called NSAIDs (non-steroidal anti-inflammatory drugs) given. These include ibuprofen or diclofenac, for example.

If these drugs do not have the desired effect, a drug from the next higher level is given. This includes low-potency opioids. If these also remain ineffective, strong opioids are administered.

In addition, medication can be injected into the affected nerve root so that the pain is treated directly at the triggering location. This is done using local anesthetics such as ropivacaine. To counteract inflammation and thus pain, a glucocorticoid can also be applied locally to the nerve root.

Are you interested in this topic? Then read our article on this below: Drugs for herniated discs

Physiotherapy for a herniated disc of L3 / L4

Physiotherapy can help to improve pain and mobility in the event of a herniated disc. Furthermore, heat therapy is often recommended. This ensures that the muscles in the back relax and thereby also reduce pain.

Massages are also available to relax the muscles, relieve pain and increase mobility in the back. In addition, the physiotherapist can recommend exercises that can also be performed at home and thus further support the healing process.

Exercises for a herniated disc

The exercises serve to stabilize the spinal column segments. It is therefore important that the muscles are stretched and strengthened. In the beginning, the focus is on stretching. To stretch the spine and muscles, the person concerned lies down on his stomach and then supports himself on his elbows, so the upper body is raised.

Care should be taken to ensure normal breathing and relaxed back muscles. The back can gradually be stretched further by lifting the upper body further and further.

There are other stretching exercises that can be performed after L3 / L4 syndrome. Once the acute phase is over, exercises to strengthen the back muscles should be performed. However, it should be ensured that the load is not too great at the beginning.

For example, the exercise "arm support with arm and leg raises" can be performed. To do this, the person concerned leans on their hands and knees, making sure that the hands are in line with the shoulders and the knees are in line with the hips. Now the right arm and the left leg are stretched out. This position is held for about 5 seconds. Then arm and leg are changed.

Which exercises are individually suitable should be discussed with the physiotherapist or doctor.

Are you more interested in this topic? Then read our next article below: Exercises for a herniated disc

When do I need an operation?

On the one hand, an operation is necessary if the pain and discomfort are reduced by conservative therapy (Medicines, physiotherapy, back training) cannot be improved. A planned operation can take place here.

On the other hand, there is an urgent indication for surgery, in which an operation should definitely be carried out within the next 24-48 hours if the muscles in the legs show an acute paralysis, sudden sensory disturbances in the area of the affected nerve or bladder and rectal evacuation disorders occur.

These voiding disorders manifest themselves in the uncontrolled discharge of urine and stool. Since these are signs that the nerves are permanently damaged, emergency surgery is inevitable.

You can read more detailed information on this here: Operation of a herniated disc of the lumbar spine

When will I get well again?

It can take a few weeks to even months for a herniated disc to heal completely. It is important to start pain therapy and exercise therapy at an early stage without putting any further strain on the spine.

If the spine and back muscles are not subsequently strengthened, herniated discs can occur again and again. Therefore prophylaxis should be taken seriously. In some cases chronic pain occurs, some of which do not go away completely after an operation.

Causes of a herniated disc

The intervertebral disc consists of a fibrous cartilaginous outer ring, the annulus fibrosus, and a gelatinous core, the nucleus pulposus. This core or parts of it emerge into the spinal canal in the event of an incident. In general, the intervertebral disc takes on a buffer function between the vertebral bodies.

A herniated disc can be caused by wear and tear of the intervertebral discs and by accidents (trauma). The vascular supply to the intervertebral discs decreases with the age of 20. This changes the structure of the outer ring of the intervertebral disc and becomes more prone to injury.

If there is a recurring load, such as carrying heavy loads, the outer ring can crack. Because the blood supply is reduced, the cracks are difficult to heal. If there is renewed stress, parts of the inner core of the intervertebral disc can escape through the cracks.

In addition to high mechanical stress, obesity and an unhealthy or unbalanced diet can lead to a herniated disc. The mechanism of a traumatic herniated disc is the same, except that immediately after the impact of violence, a tear develops in the outer ring and disc material emerges. A herniated disc can also be provoked by high-performance sport.

You can read more information on this topic here: Causes of a herniated disc

How is a herniated disc diagnosed?

If the doctor makes the diagnosis of a herniated disc, the doctor will be questioned beforehand. Information such as the beginning and course of the symptoms and whether a triggering event can be remembered is important here. The exact location of the pain, whether it is radiating and whether there are other symptoms, such as tingling or numbness, should also be inquired about.

Then the body is examined: Posture and spinal inspection are important. Feeling and patting the spine and affected area should also be performed. The nerve and muscle function should also be checked.

Is there no evidence of a serious history (for example sensory disorders, muscle paralysis, bladder function disorders), imaging does not necessarily have to be performed. If a serious course is suspected or if the symptoms persist, imaging by means of MRI, X-ray or CT is appropriate.

Are you more interested in this topic? You can read more about this: Diagnosis of a herniated disc

What can you see in an MRI of the lumbar spine?

The intervertebral discs generally appear as dark gray structures in an MRI, while the vertebral bodies take on a lighter shade of gray.

An intervertebral disc wear (Intervertebral disc degeneration) appears as a dark structure in the T2 MRI setting due to the loss of water in the intervertebral discs. If there is a herniated disc, the exit of the disc material - also as a dark gray structure - into the spinal canal can be seen.

Are you interested in this topic? Then read our next article below: MRI for a herniated disc

Anatomy digression: these are the key muscles

An identification muscle describes a functional restriction of a muscle, which with this functional failure indicates the nerve that is injured. If the roots of the spinal cord L3 / L4 are irritated, the nerves that supply the thigh muscles are affected. This includes the Quadriceps femoris muscle, M. iliopsoas and the adductors.

These muscles are responsible for stretching the leg in the knee joint (Quadriceps femoris muscle), one leg brought to the other (Adductors) and the thigh can be bent at the hip (M. iliopsoas). All of these functions can be restricted by a herniated disc.

Figure slipped disc (A), (B) and healthy disc (C)

Disc prolapse -
Nucleus pulposus prolapse

A - herniated disc from the left
B - herniated disc from above
C - Healthy disc
a - neck and chest area
b - lumbar region

Fiber ring -
Annulus fibrosus
Gelatinous core -
Nucleus pulposus
1st + 2nd intervertebral disc
(Intervertebral disc) -
Discus inter vertebralis
Spinal nerve -
Spinal nerve
Spinal cord -
Medula spinalis
Vertebral bodies -
Corpus vertebrae
Spinous process -
Spinous process