Lumbar Herniated Disc

Symptoms

The defining symptom of a lumbar herniated disc is usually leg pain rather than back pain. When disc material presses on a nerve root, pain can radiate from the lower back through the buttock and down the back or side of the leg, sometimes past the knee to the foot. This radiating pain is commonly called sciatica. It is often sharp or burning and may be accompanied by numbness, tingling, or a pins-and-needles sensation in the leg or foot.

Symptoms frequently worsen with sitting, bending forward, coughing, or sneezing, all of which raise pressure on the disc. Some patients also notice weakness in the leg or foot, such as difficulty lifting the front of the foot or rising onto the toes. The specific pattern of pain and weakness helps localize which nerve root is affected.

Diagnosis

Diagnosis begins with a history and physical examination, including tests of strength, sensation, and reflexes in the legs. A straight leg raise test, in which lifting the extended leg reproduces the radiating pain, is a useful indicator of nerve root irritation. The pattern of symptoms often tells the physician which nerve level is involved before any imaging is performed.

Magnetic resonance imaging (MRI) is the preferred study for confirming a herniated disc, because it shows the disc, the nerve roots, and the degree of compression in detail. A CT scan or X-ray may be used to assess the bony anatomy. Imaging is correlated with the clinical exam, since disc bulges are common on scans of people with no symptoms and treatment is guided by symptoms rather than images alone.

Treatment

Most lumbar herniated discs are treated without surgery. Initial care focuses on controlling pain and inflammation while the herniation resolves, which it often does as the body reabsorbs the displaced material over time. This typically includes a short period of activity modification, physical therapy to restore movement and core support, and anti-inflammatory medication. Epidural steroid injections can provide targeted relief when radicular pain is significant.

Surgery is considered when leg pain remains disabling after a course of conservative care, when weakness is progressing, or when there are signs of significant nerve compression. The most common procedure is a microdiscectomy, in which the surgeon removes the fragment of disc pressing on the nerve through a small incision using a microscope or endoscope. Because only the offending fragment is removed, most of the disc is preserved and recovery is generally quick.

At Atlantic Brain and Spine, surgical candidates are reviewed through a dedicated spine board where neurosurgeons and orthopedic spine surgeons collaborate on the plan. When a minimally invasive approach is appropriate, it is chosen to reduce muscle disruption and speed recovery.