Herniated Disc


  • Occurs when the intervertebral disk between 2 vertebrae (bones of the spine) bulges outward thus putting pressure on the spinal cord or nerve roots
  • The disk will often cause radiating pain, weakness, and sensory changes.
  • A large percentage of protruding disk will resolve spontaneously with the use of anti-inflammatory medications
  • A large number (though small percentage overall) of patients will require surgery thus making the lumbar discectomy the most common surgical procedure performed in the US
  • Disc herniations can occur in the cervical, thoracic, and lumbar spine (Upper, Middle, and Lower back)

Symptoms and Signs

  • Symptoms depend on the location and direction of the herniation
  • Back pain that is often aggrevated by weight bearing or movement
  • Pain that radiates down the leg/arm (aka radicular pain)
  • The pain often worsens with coughing or sneezing
  • Weakness or decreased sensation
  • May have bladder or other neurological problems

What is sciatica?

  • Sciatica is a term often used in conjunction with a herniated disc and refers to the pain produced by compression of the sciatic nerve roots or of the nerve itself.
  • Sciatica is a way to describe a particular set of symptoms and does not necessarily mean that the patient has a herniated disc (this is where a lot of the confussion surrounding this term is derived)
  • A characteristic pain that radiates down the lower back, into the buttock, and down the leg
  • Just a few causes of sciatica include:
  1. Herniated disc
  2. Spinal stenosis
  3. Piriformis syndrome
  4. Tumors
  5. or even pregnancy


  • More common in men



  • Medical management: Medication and physical therapy will lead to pain resolution in a large percentage of patients
  • Surgery- most surgeons will wait 5-8 weeks unless the patient has experienced cauda equina syndrome, worsening motor weakness, or intolerable pain
  • Multiple surgical options from a standard removal to a minimally invasive operation
  • Complications: Occur in about 10% of operations and consist of bleeding, infection, dural tear, nerve root injury, spinal stenosis, etc
  • Disc recurrence after a discectomy occurs in about 5-15% of patients
  • SPORT Trial- large study in the New England Journal of Medicine that demonstrated patients who chose to have an operation for lumbar disc herniation reported a greater improvement than patients who elected for nonoperative care (but this does not necessarily mean surgery is better than conservative management)


  • 85% of acute disc herniations will improve without surgery in an average of 6 weeks

Differential Diagnosis

  • Numerous types of spinal pathology
  • Tumor
  • Infection
  • Inflammation
  • Spinal stenosis
  • Subarachnoid hemorrhage
  • Dural AV Fistula


  • NEJM SPORT Trial
  • Handbook of Neurosurgery: Greenberg