Comprehensive Guide to Lumbar L5-S1 Disc Herniation: Causes, Symptoms, and Treatments

The lumbar is classified by being divided into five sections labeled as L1 – L5 vertebrae. Each of these sections can induce specific symptoms that could affect your lower back pain.

L1 — The topmost section of the lumbar spinal column.

L2 — Contains the end of the spinal cord proper. All vertebrae beyond this point only have the spinal nerves, and not the spinal cord.

L3 —  The middle vertebra of the lumbar spine

L4 — Second to last section of lumbar spinal column

L5 — The final section of the lumbar spine.

The functions of the lumbar spine include:

• Supporting the upper body
• Allowing for movement in the lower body
• Protecting the spinal cord
• Distributing your body weight
• Controlling your leg movements

The lumbar being sprained or strained are the most common forms of back pain. Back pain can be acute (short-term) or chronic (long-term).

Acute back pain typically lasts for a few days to a few weeks and is caused by overuse or injury of the back muscles. Common causes include strains, sprains, lifting heavy objects, and sudden movements such as bending or twisting. 

A lumbar sprain occurs when the ligaments that support the spine are stretched or torn while a lumbar strain occurs when the muscles of the back are overstretched or torn. The sprain or strain causes pain in the muscles of the back, which may cause a burning or aching sensation. 

Chronic back pain lasts more than three months and can result from lumbar disc degeneration, arthritis, bulging discs S1 L5, osteoporosis, scoliosis, or other conditions. It can also be affected with age, where the spinal discs are more susceptible to cracks and tears over time.  

Chronic back pain can be mild or debilitating, and it may interfere with your work, social life, and quality of life. 

Also known as the lumbosacral joint, the L5-S1 spinal motion segment is the transition region between the lumbar and lower back sacral spine. Within this region, the curvature of the spine changes from forward curve (lumbar lordosis) to backward curve (sacral kyphosis). 

The L5 to S1 spine carries the most support and has the most movement, making this area more prone to injury. The L5-S1 also helps transfer loads from the spine into the pelvis and legs.

The L5-S1 segment consists of the following structures:

• L5 and S1 vertebra: The L5 and S1 both have different features. The L5 comprises a vertebral body in front and an arch in the back with three bony protrusions. The bony protrusions include a prominent spinous process in the middle and two transverse processes on the sides. These protrusions serve as attachment points for ligaments. 

The S1, also referred to as the sacral base, is the upper and wider end of the triangular-shaped sacrum. The S1 consists of a body on the top with wing-shaped bones (alae) on either side. 

At the back, the s1 vertebra contains a long bony prominence called the median ridge. This ridge includes bony openings (foramina) on its right and left sides. The L5 and S1 are joined by the lumbosacral facet joints lined with articular cartilage.

• L5-S1 intervertebral discs: These discs are soft tissue joints composed of a hydraulic gelatinous core called the nucleus pulposus which are then encased within a firm outer collagen wall termed the annulus fibrosus. 

The S1 and L5 discs protect the spinal vertebrae and nerves from sudden impact. They also absorb shock from movements of the spine like bending, twisting, and jumping.

• L5-S1 spinal nerve: The L5 spine nerve roots exit the spinal cord through intervertebral foramina (otherwise known as small bony openings) on the right and left sides of the spinal canal. These nerve roots combine with other nerves to form bigger and larger nerves that extend down the spine and travel down each leg. 

Disc herniation occurs when the disc’s outer wall, the annulus fibrosus develops traumatic tears (annular tears), allowing the jelly-like nucleus pulposus to push backward out of the tear into the spinal canal or neural foramen.

The part that pushes through the tear is the herniation. In many cases, this hernia can impinge on a nerve, giving rise to inflammation and irritation of the affected nerve.

Disc herniation is caused by several factors which can affect the joints individually or as a combination. The most prevalent of these factors is wear and tear in the spine. As humans age, the cartilage that connects the L5-S1 discs in the spine to the corresponding vertebrae members can become lax and lose elasticity. 

Other factors include:

• Trauma
• Genetic factors
• Obesity

The most common symptom is sciatica, which is pain that radiates down the leg. Other L5-S1 disc herniation symptoms include:

• Numbness or tingling in the affected area
• Weakness in the muscles innervated by the affected nerve
• A sensation of electrical shock down the leg
• Inflammation and swelling

If the L5-S1 herniated disc presses on the spinal cord or nerves, it can cause more severe symptoms such as:

• Loss of bowel or bladder control
• Numbness in the groin or rectum
• Sudden onset of weakness in the legs
• Loss of sensation in the legs
• Difficulty walking or standing
• Paralysis

L5-S1 herniated disc is common due to a combination of anatomical, physiological, and lifestyle factors.

Lifestyle and occupational factors which includes prolonged sitting or standing, heavy physical labor, and activities that involve repetitive bending or lifting can exacerbate the risk of herniation at this level. Furthermore, the L5-S1 segment’s unique anatomical and biomechanical properties, such as the angle and motion at this joint, increase its vulnerability to degenerative changes and injuries. Conditions like osteoarthritis and spondylolisthesis commonly affect this area due to its high load-bearing function and susceptibility to wear and tear​​.

If you’re experiencing pain at the L5-S1 location, genetics, age, gender, weight, and nicotine use are among the well-identified risk factors for disc herniation, with genetic predispositions playing a crucial role in susceptibility. Certain genes related to collagen formation, L5 S1 disc degeneration, and inflammatory responses have been linked to an increased risk of herniation. The risk increases with age, particularly among individuals aged 30 to 50 years, and is more common in men than women. Obesity and smoking are also significant risk factors, as they can increase spinal load and reduce nutrient flow to the discs, respectively.​

Disc herniation is a serious condition that can cause pain, numbness, and weakness. If the herniated disc presses on the spinal cord or nerves, it can cause more severe symptoms such as bowel or bladder control loss, paralysis, or difficulty walking.

Most cases of L5-S1 disc herniation can be treated with conservative measures such as rest, ice, and heat. Chiropractic care, physical therapy, and pain medication can also be helpful. 

If the patient continues to have L1-L5 pain symptoms, doctors may prescribe medication such as non-steroidal anti-inflammatory drugs (NSAIDs) or steroids. Injection treatments such as nerve root L5 blocks can also help treat the condition.

Physical therapy may also be recommended to strengthen the muscles and ligaments around the spine. 

If nonsurgical methods fail to provide relief from the pain, your doctor may recommend surgery. There are different surgery options available for patients who have been diagnosed with herniated discs. 

When considering L5-S1 surgery, it is important to note that surgery usually involves reducing the compression on the nerve and eliminating the pain caused by the herniated disc. Patients should be aware that some surgical options carry more risk of complications than others. These complications could include infection or excessive blood loss and often tend to compromise the integrity of the spine and general patient wellbeing.

The surgical treatment selection typically depends on two factors; the associated symptoms and severity of the patient’s injury. These options range from minimally invasive surgical procedures to artificial disc replacements or spinal fusion in extreme cases. 

Before a procedure is selected, patients are advised to consult a spine expert to conduct a full MRI scan and review, and allow for a thorough examination and subsequent localized diagnosis.  

The most advanced surgery in the world for a herniated disc is the Deuk Laser Disc Repair. 

This revolutionary procedure is Deuk Spine Institute’s specialized alternative to dangerous invasive surgeries like spinal fusion or total disc replacement. The laser disc repair does not weaken or compromise the health and integrity of the spine. 

Our modernized approach to laser spine surgery has a 99.6% success rate with no complications in any patient over 15 years of performing this procedure and over 2,000 patients treated.

Deuk Laser Disc Repair surgery is a form of endoscopic spine surgery performed in our state-of-the-art surgery center under sedation while the patient relaxes. Through a ¼-inch incision, the injured disc is visualized using an endoscope and live imaging via a high-definition camera attached to the spinal endoscope. 

With this method, Dr. Deukmedjian carefully eliminates only the injured disc tissue causing pain and discomfort and leaves the rest of the patient’s own natural disc in place to preserve spinal motion and function. Fusions and artificial discs are not necessary because the patient’s repaired natural disc is left in place.

Deuk Laser Disc Repair uses a precision laser to vaporize the herniated tissue and provide the most effective laser spine surgery available. Bone and surrounding tissues are not damaged or removed during this procedure, unlike traditional microdiscectomy, artificial discs and spinal fusions. 

Dr. Ara Deukmedjian uses FDA approved tools to access the disc through a natural space in the spine where he does not drill through bone as is done with microdiscectomy. Drilling through bone weakens the spine, which leads to future complications that may require fusion surgery. 

Once the herniation and annular tear have been gently vaporized, the body can heal naturally. Irritation around the spine L5 S1 decreases, and neurological symptoms from L5 nerve root or S1 nerve root pressure subside. In time, the S1-L5 disc functions as it did before injury and herniation. 

After surgery, patients wake up to immediate relief, with the L5 S1 nerve root compression symptoms gone, and a surgical scar so small the surgeon can cover it with a Band-Aid. Only a few drops of blood are lost and no hospitalization is required. All 2,000 Deuk Laser Disc Repair surgeries done to date have been outpatient with a 1 hour recovery.

A few exercises can help relieve the pain associated with L5-S1 disc herniation. However, it is important to talk to your doctor or physical therapist before starting any exercise program.

Stretching exercises can help improve flexibility and range of motion. Hamstring stretches, hip abductor/adductor stretches, and calf stretches are all helpful.

Aerobic exercises can help increase blood flow to the area and reduce inflammation. Walking, biking and swimming are all good options.

Strengthening exercises can help support the spine and reduce the risk of future injuries. Core strengthening exercises such as crunches and planks are particularly helpful.

Avoid any exercises that cause pain. If an exercise is painful, stop doing it and talk to your doctor or physical therapist. L5/S1 exercises to avoid include hamstring curls, sit-ups, and any other exercises that put a strain on the lower back if you’re experiencing sciatica.