Lumbar Disc Herniation: Symptoms and Treatment

Symptoms

• Pain beginning in the buttock and running down the back of the thigh into the leg, sometimes to the foot (sciatica)
• Pain aggravated by coughing, sneezing and straining
• Numbness or tingling in the leg or foot
• Difficulty lifting the ankle or standing on tiptoe
• Symptoms worse with prolonged sitting, changing with walking or lying down

Seek urgent assessment for numbness around the buttocks and inner thighs, loss of bladder or bowel control, difficulty passing urine, or rapidly increasing weakness in both legs.

Diagnosis

Diagnosis rests on the history and neurological examination: the distribution of pain, muscle strength, reflexes and sensory changes indicate which nerve root is affected. MRI shows the disc and nerve roots in detail.

An important point: a herniation seen on MRI is not always the source of pain. Disc bulges are also found in people without symptoms. Treatment decisions are based on examination findings together with imaging.

Treatment

Non-surgical care resolves the majority of herniations; the displaced disc material may shrink over time. Relative rest — prolonged bed rest is not advised — appropriate pain relief, a core strengthening programme, activity modification and, in selected patients, image-guided injections form the approach.

Surgery is considered when leg pain persists despite adequate conservative treatment, when muscle weakness is progressing, or in urgent situations suggesting compression of multiple nerve roots. Modern techniques use a microscope or endoscope through a small incision, preserving the muscle — see spine surgery.