Lumbar Disc Herniation

Also known as: Lumbar intervertebral disc herniation, Lumbar herniated disc, Herniated lumbar disc, Lumbar disc prolapse, Lumbar disc extrusion, Lumbar disc protrusion, Slipped disc (lower back), LDH (lumbar disc herniation)

Last updated: December 18, 2024

Lumbar disc herniation is a condition in which the soft inner material of a disc in the lower back pushes through its outer ring and may press on nearby nerve roots. It can cause lower back pain and radiating leg pain (sciatica), sometimes with numbness or tingling in the leg, foot, or toes, though some cases have no symptoms. Many people improve over weeks to months with conservative care.

Key Facts

•Lumbar disc herniation occurs when the soft inner material of an intervertebral disc in the lower back protrudes through the outer fibrous ring, potentially compressing nearby nerve roots
•Lower back pain that vary in intensity and be localized or diffuse
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Lumbar disc herniation occurs when the soft inner material of an intervertebral disc in the lower back protrudes through the outer fibrous ring, potentially compressing nearby nerve roots. This condition may cause localized back pain, radiating leg pain (sciatica), numbness, or weakness, though some herniations can be asymptomatic.

Affected Anatomy

This condition affects several structures in and around the joint:

•Intervertebral discs of the lumbar spine (most commonly L4-L5 and L5-S1)
•Nucleus pulposus (inner gel-like disc material)
•Annulus fibrosus (outer fibrous ring of the disc)
•Lumbar nerve roots (particularly L4, L5, S1)
•Spinal canal and lateral recesses
•Surrounding ligaments and paraspinal muscles

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Lower back pain that may vary in intensity and can be localized or diffuse
•Radiating leg pain (sciatica) that may follow a dermatomal pattern, often described as sharp, burning, or electric
•Numbness or tingling in the leg, foot, or toes corresponding to the affected nerve root
•Weakness in specific muscle groups, such as foot drop or difficulty with toe raises, depending on the level of herniation
•Pain that may worsen with sitting, bending, coughing, or sneezing
•Stiffness or reduced range of motion in the lower back
•In rare severe cases, bladder or bowel dysfunction may occur and requires urgent evaluation

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Age-related disc degeneration can weaken the annulus fibrosus and predispose to herniation
•Acute trauma or injury, such as heavy lifting with improper technique, can contribute to disc herniation
•Repetitive mechanical stress or twisting motions may contribute over time
•Genetic factors may influence disc structure and susceptibility to degeneration
•Occupational factors involving prolonged sitting, vibration, or repetitive loading may increase risk

Risk Factors

•Age between 30 and 50 years, when discs may begin degenerating while still retaining sufficient nucleus material to herniate
•Occupations involving repetitive lifting, bending, or prolonged sitting may increase risk
•Obesity or excess body weight can increase mechanical load on lumbar discs
•Sedentary lifestyle and weak core musculature may contribute to risk
•Smoking may impair disc nutrition and accelerate degeneration
•Genetic predisposition to disc degeneration or connective tissue weakness
•Prior lumbar disc problems or spine surgery may increase risk of recurrence

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Medical history and symptom review can help characterize pain patterns, neurological symptoms, and functional impact
•Physical examination typically includes assessment of gait, posture, range of motion, and neurological function including strength, sensation, and reflexes
•Straight leg raise test and other provocative maneuvers may help identify nerve root involvement
•MRI is often the preferred imaging modality for visualizing disc herniation and nerve compression
•CT scan may be used when MRI is contraindicated or for better bone detail
•Electrodiagnostic studies (EMG/nerve conduction) may help localize nerve involvement or assess severity in some cases
•Plain X-rays may help assess alignment and rule out other causes but do not directly visualize disc herniations

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and brief relative rest, avoiding positions that worsens symptoms
•Muscle relaxants may help manage associated muscle spasm

Physical Therapy and Exercise

•Physical therapy focusing on core stabilization, flexibility, and proper body mechanics
•Heat or ice application and other modalities may help with symptom management

Medications

•Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation for some individuals

Injections and Office-Based Procedures

•Oral corticosteroids may be used short-term for severe radicular symptoms in some cases
•Epidural steroid injections may provide temporary relief of radicular symptoms for some individuals

Surgery

•Surgical options such as microdiscectomy or laminectomy may be considered for persistent or severe symptoms, progressive neurological deficits, or cauda equina syndrome

Prognosis and Recovery

The course of this condition varies between individuals:

•Many individuals with lumbar disc herniation may improve with conservative treatment over weeks to months
•Natural history studies suggest that many herniations may decrease in size over time
•Some individuals may experience recurrent symptoms or require ongoing management
•Surgical intervention, when indicated, generally has favorable outcomes for leg pain relief
•Recovery timeline and degree of improvement can vary based on severity, duration of symptoms, and individual factors

Lumbar Discectomy (Microdiscectomy)(Procedure)
Sciatica(Condition)
Lumbar Spinal Stenosis(Condition)

Frequently Asked Questions

Common symptoms include: Lower back pain that may vary in intensity and can be localized or diffuse; Radiating leg pain (sciatica) that may follow a dermatomal pattern, often described as sharp, burning, or electric; Numbness or tingling in the leg, foot, or toes corresponding to the affected nerve root; Weakness in specific muscle groups, such as foot drop or difficulty with toe raises, depending on the level of herniation; Pain that may worsen with sitting, bending, coughing, or sneezing.

Diagnosis typically involves: Medical history and symptom review can help characterize pain patterns, neurological symptoms, and functional impact; Physical examination typically includes assessment of gait, posture, range of motion, and neurological function including strength, sensation, and reflexes; Straight leg raise test and other provocative maneuvers may help identify nerve root involvement; MRI is often the preferred imaging modality for visualizing disc herniation and nerve compression.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and brief relative rest, avoiding positions that worsen symptoms; Physical therapy focusing on core stabilization, flexibility, and proper body mechanics; Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation for some individuals; Oral corticosteroids may be used short-term for severe radicular symptoms in some cases; Muscle relaxants may help manage associated muscle spasm.