A lumbar disc herniation occurs when a disc between the lumbar vertebrae bulges out and presses on a nerve root. Pain and numbness radiating down the leg are the typical symptoms. Most patients recover without surgery.
What is a lumbar disc herniation?
Between the vertebrae are discs that act as shock absorbers. When the gel-like core (nucleus) pushes out through a tear in the outer ring (annulus), it is called a disc herniation — often described as a "slipped disc". In the lower back it most commonly occurs at the L4-L5 and L5-S1 levels. The herniated disc material presses on a nearby nerve root and triggers inflammation, causing pain.
Risk factors
- Age-related disc wear (degeneration)
- Heavy lifting, sudden strain and poor posture
- Prolonged sitting and inactivity
- Excess weight and smoking
- Genetic predisposition
Symptoms
- Lower back pain
- Pain radiating from the buttock down the leg, sometimes to the foot (sciatica)
- Numbness or tingling in the leg or foot
- Weakness of the ankle or big toe
- Pain that worsens with coughing, sneezing or straining
Emergency: Loss of bladder or bowel control or inability to pass urine, numbness in the groin and buttocks, and weakness in both legs can be signs of "cauda equina syndrome" and require urgent surgical assessment.
Diagnosis
The diagnosis is based on the symptoms and neurological examination. Lumbar MRI best shows the location of the herniation and its relationship to the nerve root. EMG may be performed when needed to assess the degree of nerve damage. Not every disc bulge seen on MRI explains the symptoms; findings are interpreted together with the examination.
Treatment Approach
Most patients with a lumbar disc herniation recover within a few weeks to a few months with non-surgical treatment:
- Brief rest followed by a controlled return to daily activities
- Pain relievers and muscle relaxants
- Physiotherapy and exercises to strengthen the back muscles
- Interventional pain treatments such as epidural steroid injection in suitable patients
Surgery is recommended in the following situations:
- Progressive or significant weakness
- Cauda equina syndrome (emergency)
- Persistent pain that limits daily life despite an adequate period of non-surgical treatment
The usual operation is microdiscectomy, performed under a microscope through a small incision: the herniated disc fragment is removed to relieve pressure on the nerve. Patients start walking early after surgery.