What is a herniated disc?
The discs between the vertebrae act as flexible cushions. Each has a firm outer ring surrounding a softer center. A herniation occurs when disc material pushes through the outer ring and irritates or compresses a nearby nerve.
Symptoms
A lumbar disc herniation can cause low-back pain, but nerve symptoms in the leg are often more noticeable. These may include sciatica, burning or electric pain, numbness, tingling, or weakness. The exact pattern depends on which nerve is affected.
Urgent
Seek urgent care for new loss of bowel or bladder control, numbness in the saddle area, or rapidly worsening leg weakness.
How it is diagnosed
Diagnosis starts with the history and the examination, not the scan. Where the pain travels, which movements provoke it, and what the reflexes, strength, and sensation show all point to a particular nerve. An MRI is the usual imaging study, because it shows the disc and the nerve together. X-rays add alignment and are taken standing.
The important step is matching the two. Disc bulges are common on MRI in people with no symptoms at all, so a finding only matters when it explains the symptoms you actually have. If the scan and the examination disagree, that is worth understanding before anyone discusses surgery.
Non-surgical treatment
Most lumbar disc herniations improve without surgery. Depending on your symptoms and examination, early treatment may include activity modification, anti-inflammatory medication when safe, guided physical therapy, and time. An epidural injection may be considered when leg pain remains limiting.
Surgical options
Surgery may be considered when pain remains severe despite appropriate nonsurgical care, weakness is progressing, or urgent neurological symptoms develop. The goal of decompression is to remove the small fragment pressing on the nerve while preserving healthy anatomy. Endoscopic or tubular techniques may be options for selected patients.