Lumbosacral disc herniation

A lumbar disc herniation occurs when a disc in the lower back bulges or ruptures and presses on a nearby nerve. This is a common cause of leg pain, often referred to as sciatica.

Quick Facts:

  • Common cause of leg pain (sciatica)
  • Often improves without surgery
  • May cause numbness or weakness in the leg
  • Surgery is reserved for persistent or severe cases

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WHAT IS A LUMBAR DISC HERNIATION?

Discs act as cushions between the bones of the spine. When a disc becomes damaged, part of it can push outward and press on a nearby nerve.

This is called a disc herniation.

When a nerve is compressed, symptoms often travel along that nerve into the:

  • Buttock
  • Leg
  • Foot

👉 This is why patients often feel leg pain more than back pain

IS THIS SERIOUS?

In most cases, a lumbar disc herniation is not dangerous and improves with time.

Typical Cases

  • Leg pain and discomfort
  • Symptoms improve over weeks to months
  • Managed without surgery

More Severe Cases

  • Persistent or worsening pain
  • Weakness in the leg
  • Significant nerve compression

👉 The key is whether symptoms are improving or progressing

SYMPTOMS

Common Symptoms

  • Low back pain
  • Leg pain (sciatica)
  • Pain that travels down the leg
  • Burning or sharp pain

Nerve-Related Symptoms

  • Numbness or tingling
  • Weakness in the leg or foot

Classic Pattern

  • Leg pain is often worse than back pain
  • Pain may worsen with sitting, bending, or coughing

🚨 When to Seek Prompt Evaluation

  • Progressive leg weakness
  • Difficulty walking
  • Loss of bowel or bladder control
  • Severe or worsening symptoms

👉 These may indicate significant nerve compression

CAUSES & RISK FACTORS

Common Causes

  • Disc degeneration over time
  • Sudden strain or lifting injury
  • Repetitive stress

Risk Factors

  • Aging
  • Sedentary lifestyle
  • Poor body mechanics
  • Smoking
  • Genetics

HOW IS THIS DIAGNOSED?

A. Clinical Evaluation

Diagnosis begins with:

  • Symptom history
  • Physical exam
  • Evaluation of strength, sensation, and reflexes

B. Imaging

  • MRI (most important test) to visualize disc and nerve compression
  • X-rays for alignment
  • CT scan in select cases

👉 Imaging should match the patient’s symptoms

TREATMENT OPTIONS

A. Non-Surgical Treatment

Most patients improve without surgery.

Common treatments include:

  • Physical therapy
  • Activity modification
  • Anti-inflammatory medications
  • Gradual return to activity
  • Epidural steroid injections in select cases

👉 Many patients improve over several weeks

B. When Is Surgery Considered?

Surgery may be considered when:

  • Symptoms persist despite conservative care
  • Pain is severe and limiting function
  • There is progressive weakness
  • Imaging clearly shows nerve compression

C. Surgical Options

When surgery is needed, options may include:

Lumbar Microdiscectomy

  • Removal of the portion of disc pressing on the nerve
  • Minimally invasive approach
  • Often provides rapid relief of leg pain

👉 The goal is to relieve nerve pressure while preserving spine stability

OUR APPROACH

Weocus on treating the nerve symptoms—not just the imaging.

  • Many disc herniations improve with time
  • We emphasize non-surgical treatment first when appropriate
  • Surgery is recommended when there is clear benefit
  • When surgery is needed, the goal is reliable relief of leg pain with a minimally invasive approach

👉 The key is identifying who will benefit from surgery and who will improve without it

WHAT TO EXPECT

Before Treatment

  • Evaluation of symptoms and neurologic exam
  • MRI to confirm diagnosis

During Non-Surgical Care

  • Gradual improvement is common
  • Focus on reducing inflammation and restoring function

If Surgery Is Needed

  • Typically a well-tolerated procedure
  • Many patients experience rapid improvement in leg pain
  • Recovery varies but is often quicker than expected

OUTCOMES & RISKS

Outcomes

  • Most patients improve without surgery
  • Surgical outcomes are excellent when:
    • Symptoms match imaging
    • Nerve compression is clearly identified

Risks of Untreated Severe Cases

  • Persistent pain
  • Weakness
  • Nerve damage (rare but possible if severe compression persists)

FREQUENTLY ASKED QUESTIONS

Will this heal on its own?
In many cases, yes.

Why does my leg hurt more than my back?
Because the nerve is being irritated.

When should I consider surgery?
When symptoms persist, worsen, or include weakness.

Will surgery fix the problem completely?
Surgery is very effective for relieving leg pain caused by nerve compression.

FOR REFERRING PHYSICIANS

  • Refer patients with:
    • Persistent radiculopathy
    • Motor weakness
    • Failure of conservative treatment
    • MRI showing disc herniation with nerve compression
  • Imaging:
    • MRI lumbar spine is key
  • Urgent referral for:
    • Progressive motor deficit
    • Cauda equina symptoms
    • Severe neurologic findings

Next Steps…

👉 Request an Appointment
👉 Refer a Patient