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What is the fourth letter of the alphabet?


One of the most common reasons people see a spine specialist is for treatment of pain in the lower back (called the lumbar spine) and for pain in one or both legs, which is called sciatica. This back pain is often caused by a lumbar disc herniation, which is known by a variety of names including a slipped disc, ruptured disc or herniated disc. Atlantic Spine Specialists in Morristown, New Jersey, has two renowned fellowship-trained, board-certified spine surgeons who specialize in treating disc herniation. Dr. Carl Giordano and Dr. Richard Nachwalter possess years of experience diagnosing and treating herniated discs as well as many other spinal conditions.

To learn more about lumbar disc herniation, request a consultation at Atlantic Spine Specialists in Morristown, New Jersey. Or you can call us at (973) 971-3500 to schedule your appointment.

About the Lumbar Spine

To understand sciatic nerve pain, it’s helpful to have a basic understanding of the lumbar and sacral spine anatomy. The lumbar spine is made up of five bones called vertebrae, which are numbered from top to bottom as L1 to L5. The sacral spine follows and includes the next three vertebrae numbered S1 to S3. The lumbar spinal nerves begin with nerve roots that branch from the spinal cord. Each is named for the vertebra immediately above; spinal nerve L4 exits the spinal canal below the lumbar vertebra L4.

The sciatic nerves, which run down each leg, are made up of spinal nerves L4 to S3. These nerves begin in the lower back (lumbar spine) and run down the back of each leg. They are the longest nerves in the body.

For a visual reference you can watch an animated overview of sciatica.


Symptoms of a herniated lumbar disc can occur in the lower back, hips, legs and buttocks. Patients typically experience one or a combination of the following:

  • Discomfort or pain that radiates from the lower back, down one or both legs and possibly to the feet
  • Constant shooting pain that may increase when moving or sitting
  • Leg weakness
  • Numbness and tingling in the leg or foot
  • Limited range of motion
  • Difficulty walking
  • Problems with bladder or bowel control in severe cases

For a visual reference you can watch animations of lumbar disc herniation.


Herniated discs are usually caused by disc degeneration due to aging and most often occur in people who are 35 to 55. Sometimes trauma, heavy lifting or sudden twisting can cause a disc to suddenly rupture.


Accurate diagnosis is the key to appropriate and effective treatment for your pain. Doctors Giordano and Nachwalter are highly experienced in diagnosing spinal disorders as well as providing both surgical and non-surgical care. During your consultation, your doctor will:

  • Review your symptoms (such as where you have pain, weakness, and numbness) and what limitations these symptoms place on your everyday activities
  • Perform a physical exam including an assessment of nerve function, muscle strength, response to sensory input (such as pressure and touch) and check reflexes
  • Evaluate your medical history
  • Order diagnostic tests such as x-rays, CT and MRI scans or review the results of scans you have already had

Your doctor will review treatment options once he has diagnosed your condition and determined the cause of your symptoms. He will review the risks and benefits of each option and assist you in deciding which one is best for you.


Dr. Giordano and Dr. Nachwalter take a conservative approach to treatment of spinal conditions. They recommend surgery as a last resort when symptoms do not improve with non-surgical treatment. Treatment for a herniated lumbar disc may include:

  • Modified activity
  • Medication
  • Steroid injections
  • Physical therapy
  • A surgical procedure such as lumbar discectomy.


Dr. Nachwalter is participating in United Healthcare/Oxford

Horizon Blue Cross


Both Dr. Giordano and Dr. Nachwalter will be participating in Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross

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