Lumbar Disc Herniation

A lumbar disc herniation occurs when the soft inner core of a spinal disc in the lower back pushes through a tear or weak spot in its tough outer layer.
When this disc material presses on nearby nerves, it can cause lower back pain, sciatica, and nerve-related symptoms in the hips, legs, or feet.

This is one of the most common causes of leg pain and disability, and with early diagnosis and treatment, many patients can find lasting relief.

Lumbar disc herniations can develop gradually over time or suddenly due to injury.
Common causes include:

• Natural aging and disc degeneration – discs lose water content and flexibility, making them prone to tearing or bulging.
• Repetitive strain or heavy lifting – bending, twisting, or improper lifting techniques increase pressure on the discs.
• Sudden trauma – falls, car accidents, or sports injuries can damage a disc.
• Genetics – some individuals are more prone to disc problems due to inherited factors.
• Lifestyle factors – smoking, obesity, and lack of core strength accelerate disc wear and tear.
• Poor posture or ergonomics – long-term sitting or improper alignment puts extra stress on the lower spine.

Symptoms depend on the size of the herniation and which nerve is compressed.
They often affect one side of the body and may include:

• Lower back pain that may be sharp, aching, or radiating.
• Sciatica: shooting or burning pain radiating from the lower back through the buttock and down the leg.
• Numbness or tingling (“pins and needles”) in the leg, foot, or toes.
• Muscle weakness that makes it difficult to stand, walk, or lift the foot (foot drop).
• Pain that worsens with coughing, sneezing, or sitting for long periods.
• Severe or urgent symptoms: sudden loss of bladder or bowel control or rapidly worsening weakness — requires immediate medical attention.
   

Dr. Fried takes a comprehensive approach to accurately diagnose lumbar disc herniations:

• Medical history: discussion of symptoms, onset, and activity level.
• Physical and neurological exam: checking reflexes, strength, flexibility, and sensation 
• Imaging studies:
  • MRI: the gold standard for visualizing disc herniations and nerve compression.
  • X-rays: to assess alignment, instability, or degenerative changes.
  • CT scans: occasionally used for complex or surgical planning.
• Diagnostic injections: may help confirm the exact source of pain and guide treatment.
  
   

Most lumbar disc herniations do not require surgery.
Dr. Fried emphasizes conservative care first, reserving surgery for cases where pain is severe, symptoms are worsening, or neurological function is at risk.