Herniated Disc — Lumbar
A herniated disc in the lower back presses on the nerves that run into your legs. This is one of the most common causes of sciatica.
Also Called: Slipped disc, ruptured disc, bulging disc, disc protrusion, disc extrusion. These describe stages of the same problem. As the outer wall weakens, the disc can bulge, then protrude, then tear open enough for the inner material to escape.
What It Is
Each disc has a tough outer ring around a soft center, like a jelly donut between two bones. When the outer ring weakens or tears, the soft center pushes out or squeezes through. That is a herniated disc. In the lower back it often presses on a nerve root heading into the leg. The pressure and the inflammation it causes produce the leg pain most people call sciatica.
Causes & Risk Factors
Discs lose water and flexibility with age, which makes the outer ring easier to tear. A lift, twist, or bend is often the trigger people remember, though the disc was usually weak before that moment. Smoking speeds up disc degeneration. Repetitive heavy lifting, a sedentary lifestyle, and genetics all play a part.
Symptoms
- Sharp, electric, or burning pain down one leg
- Numbness or tingling in the leg or foot
- Weakness in the leg or foot
- Some patients also have significant back pain; others feel it almost entirely in the leg
Diagnosis
The diagnosis starts with where the pain is and what changes it. Dr. Hirsch will ask when the symptoms began, where in the leg they travel, whether it is the front, the side, or the back of the leg, and what makes them better or worse, because that pattern points to which nerve is involved before any imaging is opened. An MRI then confirms it.
Imaging on its own does not make the diagnosis, since disc bulges and degenerative changes appear on the scans of people who have no symptoms at all, so the finding has to match the symptom pattern before it explains anything.
Treatment
Most lumbar disc herniations are treated without surgery and most of them improve. Non-surgical care falls into three categories: anti-inflammatory and other pain medications, physical therapy to strengthen the muscles that support the spine and take load off the disc, and targeted injections such as an epidural steroid injection. None of these is meant to be used indefinitely. They are there to carry you through the acute phase while the herniation quiets down, which for most patients happens over roughly six to eight weeks.
Surgery is considered when a complete course of non-surgical treatment has not relieved the symptoms, or when weakness or another neurological problem makes waiting inappropriate.
Endoscopic Discectomy
The most common operation for a herniated disc pressing on a nerve. The fragment sitting on the nerve is removed through a dime-sized incision, with the instrument passed between the muscle fibers rather than detaching them from the bone. Most patients go home the same day.
Lumbar Disc Replacement
When the herniation sits centrally in the canal, or when the disc itself has worn out far enough to have become a source of back pain on its own, replacing the disc addresses the nerve compression and the disc together, and the implant preserves motion at that level.
Minimally Invasive Fusion
Fusion is reserved for cases where the segment has become unstable, or where alignment has to be reconstructed, since those are problems a decompression or a disc replacement cannot address.
Dr. Hirsch is board-certified and Yale-trained. Read his full background.