The L4-L5 segment of the level or level is the most common place to find bulging discs at the lower back. Your belt line is the L4-L5. It is responsible for 95% of the bending and twisting movements that involve the waist. It is also the most burdened segment of the spine, because they support the upper body with load-bearing duties. The L4-L5 segment is a frequent site for disc bulges and herniations. It also has protrusions, prolapses and extrusions. This article will give you detailed information about the L4-L5 segment of your spine to help you understand what to do to get well without any surgery or injections.
Common causes of lower back pain (backaches) include the L4-L5 segment and the L5-L5 spine segment. Sciatic-like symptoms can be caused by a L4-L5 disc bulge. Pinched nerves are most commonly caused by a slipped disc. A L4-L5 disc bulge, slip-disc (slipped disc) can pinch the nerve and cause serious health problems, such as impotence, reproduction problems, infertility and loss of bladder and bowel control. Pinched nerves at the L4–L5 level can also be caused by bone-spurs or ligament thickening (hypertrophy ligamentum flavum).
This article will provide detailed information about the L4-L5 segments as well as the common conditions that can arise from them. An L4-L5 segment of the spine can be treated without injection or surgery, regardless of its cause. Corrective treatments that address the root cause of the problem are key to successful recovery. Before we get into the details about disorders and treatment options, let’s first discuss the low back (lumbar spine).
Function of the Lumbar Spine
Also known as the lower back, the lumbar spine can also be called the lower back. It is complex. The lumbar spine has a total of 5 vertebral bones. Each one is connected to an intervertebral, working in close collaboration with the surrounding muscles, joints and nerves to allow for a dynamic range and weight-bearing. The L4-L5 disc space is the second-lowest, while the L5-S is the lowest. As it is responsible for 95% of the bending at the waist, the L4-L5 segment of the spinal disc is the most important. Most back pain sufferers have L4-L5 disc bulge disorders.
A herniated disc is the most common cause of disability and spinal canal stenosis. You are also more likely to experience degenerative changes and eventually disc herniation (slip disc or slipped disc).
How does the Spinal Disc get damaged?
The intervertebral discs consist of two parts: the annulus fibrosus at the outer rim, and the nucleus pilosus at the inner portion. The inner portion (nucleus pulposus), can protrude through an outer ring due to repetitive trauma, axial loading of spine, injury or weakness of lower back muscles. You may experience a variety of disc problems, including disc bulge, disc herniation or prolapsed disc.
Impingement of the existing nerve root, or nerve roots, can be caused by a slipped disc. In severe cases, an L4 disc herniation may impinge on multiple traversing nerve root inflections: L5 nerve root and even the S1 nerve roots. One slip disc can pinch multiple nerve roots and the spinal cord. L4-L5 surgery is popular because of nerve root impingement or spinal cord compression. Before we discuss L4-L5 surgery, lumbar fusion or other forms of spine surgery, we want to review some common symptoms that can be associated with L4-L5 nerve root impingement.
Common Problems Associated With The L4-L5 Spinal Segments
We have listed the most common conditions that affect the L4-L5 spine segments to help you understand why your low back pain is occurring.
- Muscular and ligamentous Disorders
- Disorders of the spine joint or facet joints
- Slip-disc (slip-disc).
- Spinal canal stenosis
- Foraminal stenosis
- Muscle and Ligament Disorders at L4-L5
Common muscular and ligamentous problems that can cause concern include injury, damage, and disorders of the ligamentum flavum. The L4-L5 segments of the ligamentum flavum are a common area for muscle and ligament problems. These issues are common in nearly all people over 40 years old. But, simply having muscle or ligament problems will not cause severe pain. When they are damaged, a muscular or ligamentous cause of back pain is possible.
Ligamentum flavum, a ligament that has muscle characteristics, is called Ligamentum flavum. It has contractile capabilities. Hypertrophy of the ligamentum flavum can lead to damage to the ligamentum flavum, which compresses both the nerve and spinal cord.
Spinal Joint Disorders
The L4-L5 segment of the spinal column is the most mobile in the lower back and the most burdened. These segments are also subject to excessive weight bearing activities such as sitting. The cartilage of the spine’s facet joints and spinal joints is made up of synovial membranes. Standing or sitting stress can cause fluid accumulation in the joints. Fluid accumulation is a major factor in joint damage (facet hypertrophy), and bone spurs (arthritis).
L4-L5 Slip-Disc (Slipped Disc)
Protruding, bulging, herniated and protruded discs are medical terms that refer to a slipped disc. An L4-L5 slip disc is when the L4-L5 spinal disc wears out or degenerates. The L4-L5 segment is the most common location for disc bulge and spinal disc degeneration.
L4-L5 slip discs (herniated, bulged), can compress the thecal sac (spinal cord fibers) or spinal nerves. A spinal cord fiber or nerve can be compressed or impinged by even the smallest amount. Nerve degeneration is caused by nerve compression. Nerve weakness, paralysis, and nerve pain are all caused by nerve degenerative changes.
A slipped disc, bone spur, spinal misalignment, subluxations, spondylolisthesis and ligamentous issues can all lead to a compressed nerve. The second most common reason for a compressed nerve is bone-spurs (arthritis) and spondylosis. No matter what the reason, compressed nerves require immediate attention, particularly at the L4–L5 segment of your lower back.
Spondylolisthesis at L4-L5
L4-L5 Spondylolisthesis refers to a congenital condition or acquired condition (degenerative, spondylolisthesis). It is when one vertebra slips forward to the vertebrae below. Spondylolisthesis is a condition where one vertebra slips on the other. It is graded according to its severity. :
- Grade I spondylolisthesis – Forward slippage less than 24%
- Grade II spondylolisthesis – Slippage of 25-49%
- Grade III spondylolisthesis – Slippage of 50-74%
- And A Grade IV spondylolisthesis – slippage of more than 75%
Co-conditions are always present in spondylolisthesis. These are the most common co-conditions that are associated with spondylolisthesis:
- Hypertrophy of the ligamentum flavum: Thickening within the canal of a spinal nerve
- Facet Hypertrophy: Bone spurs, arthritis
- Disc Degeneration: The wear and tear on spinal discs
- Joint Degeneration: Damage to spinal joints
- Spinal canal stenosis – shrinkage in the size of the spinal canal
- Foraminal Stenosis – Shrinkage of the spinal nerves’ exit points
Spondylolisthesis is a serious problem. The L4-L5 segment of the spinal segment can lead to leg pain, back pain, sciatica, and leg pain. It can also lead to weakness in the legs, loss or control of the bladder and bowels, paralysis, and reproductive problems. Surgery is not required for both acquired and degenerative forms of spondylolisthesis.
What is an L4-L5 spondylosis?
Spondylosis can be described as a loose term that describes spinal disc disorders and spinal joint disorders leading to nerve root irritation. Spondylosis is most common at the L4-L5 segment. The symptoms of spondylosis in the L4-L5 segment can vary. The severity of nerve compression caused by spondylosis will determine the symptoms. But, just because you don’t feel any pain doesn’t mean that there is no spondylosis. Most people will only experience spondylosis as asymptomatic (cause of pain) in the later stages. Below are common symptoms that can be seen in spondylosis of various degrees at L4-L5.
- Mild L4/L5 spondylosis can cause back pain.
- L4-L5 moderate spondylosis can cause back pain, pain around the buttocks and hips, legs, feet, or thighs. It can also lead to numbness, weakness, or tingling in the legs, feet, and toes.
- Severe L4/L5 spondylosis can cause severe back pain, weakness, bladder and bowel problems, erectile dysfunction and reproductive problems in females and men. It can lead to paralysis, partial or total.
What are the Dangers of a Canal Stenosis at The L4-L5 Level
Spinal stenosis can cause pain and disability. Lower back stenosis is most common at the L4-L5 levels. Spinal stenosis is caused by premature wear and tear on spinal joints, muscles and ligaments. A progressive disorder is the shrinkage or stenosis in the spinal canal. This means that once shrinkage begins, it will continue to progress.
Progression can lead to complete or partial damage to nerves and spinal cord. Any reduction in the spinal canal should be considered a concern, particularly if it is below the L4-L5 levels. These conditions are serious because they can lead to paralysis or weakness of the lower limbs, infertility, loss of bladder control, and impotence.
L4-L5 Foraminal Stenosis
Canal stenosis is a shrinkage in the spinal canal, or housing of the spinal cord. Foraminal stenosis refers to the narrowing of the space between the spinal segments. Foramina shrinks due to spinal disc degeneration, facet hypertrophy, ligamentous issues (ligamentum falum hypertrophy), and bone spurs (arthritis). L4-L5 foraminal stenosis is the most common cause of sciatica, back pain, leg pain, numbness and weakness in the legs.
Symptoms Of Lumbar Spinal Segment (L4-L5)
Lower back pain can radiate to either one or both of the lower limbs. There may be tingling, pins and needles sensations or a burning sensation on the top and bottom of the feet. A L4-L5 slip disc can cause weakness in the feet or legs. Some people may be unable to walk or have difficulty standing. A condition known as “foot drop” is when someone can’t walk or stand.
Footdrop patients often present with a high-steppage gait, where the patient exaggeratedly raises their thigh while walking like they are climbing stairs. A slapping gate is also common, in which the foot hits the ground while they walk. Drop foot is a serious condition that causes damage to the nerves controlling foot and leg movements. The severity of a slip disc will determine the extent of the injury. A slipped disc patient should seek non-surgical treatment as soon as possible.
Disc problems are a common back problem today. They can also be the most painful. This is especially true for the L4-L5 area of the disc. It can cause additional, painful symptoms that can disrupt your life and send you to the doctor. Are you unsure if your symptoms are caused by a L4-L5 slip disc problem? These are the signs you should be looking for.
Chronic lower back pain
There are many meanings to pain in the lumbar area. The way that the pain is presented may help you determine the problem. A bulging disc at L4/5 may first be noticed by pain. Your lower back may be hurting near the top of you pelvis. The pain can be exacerbated if you press on the nerve near your spine. It may also increase if you cough or sneeze.
Your pain will be worsened by daily activities such as sitting or bending for prolonged periods of time. It is possible to have trouble sleeping at night.
Leg pain or weakness
Sciatica is often the name given to leg pain caused by a L4-L5 disc issue. This is also a sign that your back pain could be caused by a disc problem. It is not uncommon for back pain sufferers to feel pain radiating down their legs along the sciatic nerve.
This is not the only type of sciatica pain. “Symptoms may include dull, sharp burning, aching, or stabbing.
It may get worse if you sit for a long time, laugh, sneeze, or cough. It is possible to worsen the condition by walking.
Tingling and Numbness
You may feel tingling, numbness or pins-and-needles sensations from the L4-L5 disc area if your disc presses on a nerve. WebMD states that the feeling of numbness can be felt in one leg. It may start in the buttock, behind the knee, and then extend to the ankle or foot.
Livestrong said that if nerves are damaged and pain is felt in the feet, it’s most often “along the top of your foot” or “between your big toes and second toe.” “Tingling or numbness can come and go depending on where your back is, but it could be constant.”
Anatomy and Structure of the L4-L5 Spinal Motion Section
These structures are included in the L4-L5 motion segment:
L4 and L5 vertebrae. Each vertebra is composed of a vertebral head in the front and a back vertebral arch. Three bony protrusions make up the vertebral arch: a prominent spinous process in its middle and two transverse processing on either side. The lamina is the region between the spinous and transverse processes. The pedicle is the region between the transverse and vertebral bodies. Facet joints (zygapophyseal joint) connect the vertebrae. They are covered with articulating cartilage, which allows for smooth movement between the joint surfaces.
L4 and L5 vertebral bodies stand taller in front than they do behind. Bony endplates protect the spine from compressive loads by covering the upper and lower vertebral bodies.
L4-L5 intervertebral disc. Between the L4 and L5 vertebral bodies is a disc made from a gel-like material (nucleus pilosus), and surrounded by thick fibrous rings (annulus fibrosus). This disc protects the vertebrae against grinding during spinal movements by providing cushioning and shock-absorbing function.
The L4-L5 disc’s height plays an important part in maintaining the lordosis, or inner curvature of the lumbar spine.
L4 spinal nerve. The L4 spinal nerve roots leave the spinal cord via small bony openings (intervertebral foramina), on the right and justify sides of the spinal canal. These nerve roots combine with other nerves to form larger nerves that travel down each leg and extend down the spine.
L4 dermatome: This is an area of skin that feels sensations from the L4 spinal cord. It includes the parts of the leg, thigh and foot.
The L4 myotome, which is a grouping of muscles controlled via the L4 spinal nerve, includes parts from several muscles in the back and pelvis.
The L4-L5 motion section provides a bony enclosure to the cauda, which is the lower portion of the spinal cord’s nerves.
Common Problems in L4-L5
Some of the most common injuries and disorders at the L4–L5 motion segment are:
Facet joint problems. This motion segment is prone to facet-related problems due to its high mobility at L4 and L5. Synovial cyst formation (fluid-filled sac), osteoarthritis, and instability of the faces.
Problems with discs. High risk of disc degeneration in the L4-L5 disc. The increased load at the L4–L5 motion segment, and the decreased movement in segments below it, may contribute to this risk. Degeneration can cause a change in the disc height that may impact the lumbar spine’s lordosis.2 Injuries or degeneration could also cause the disc to herniate.
Spondylolysis. Spondylolysis is a fracture of the pars interarticularis, a small section of bone that connects the facet joints to the vertebral ar.2 This can happen at the L4–L5 level because of concentrations of compressive loads. Pars stress reactions are a condition where the bone becomes stressed, rather than breaking.
Degenerative spondylolisthesis. Degenerative changes can lead to L4-L5 slippage on L5 due to changes in the angle of the L4/L5 facet joint.
Spinal stenosis. The presence of bone spurs, abnormal bone growth, or other degenerative conditions may lead to a narrowing of the bony nerve openings. This can cause stenosis.
External trauma, such as falls or motor vehicle accidents, may result in facet joint fractures, dislocation, or damage to this level. Rarely, tumors or infections can affect the L4-L5 spinal segment and vertebrae.
Non-surgical treatments can relieve pressure on the nerves from a slipped disc
L4-L5 Lumbar discs often place varying degrees of pressure on nerves when they bulge or herniation. A slipped disc, or slip-disc, can place significant pressure on the nerves exiting the spine. To relieve the pressure on the nerves, spine surgeons will often try to destroy the nerve using Radiofrequency Ablation (RFA) or RF Neurotomy. But, these surgical interventions are not well-reviewed in the long-term. Patients who had surgery to repair an L4-L5 disc frequently return for further procedures.
The best way to relieve pressure on nerves caused by herniated, bulging or extruded Lumbar Discs is to not have surgery.