What is a herniated disc?
Each spinal disc consists of a tough outer ring (the annulus fibrosus) surrounding a soft gel-like center (the nucleus pulposus). A herniated disc — also called a slipped or ruptured disc — occurs when the nucleus pushes through a tear in the annulus and presses on an adjacent nerve root or, in severe cases, the spinal cord itself.
In the cervical spine, a herniated disc typically causes pain that radiates from the neck into the shoulder, arm, or hand — often accompanied by numbness, tingling, or weakness. In the lumbar spine, a herniated disc at L4-L5 or L5-S1 typically causes sciatica: sharp radiating pain down the buttock and leg, sometimes all the way to the foot.
The good news is that the majority of herniated discs improve with conservative treatment over six to twelve weeks. The body's own inflammatory response gradually reabsorbs the herniated material. Surgery is reserved for patients who do not improve with conservative care, who have significant neurological deficits, or who have severe pain that is not responding to other treatments.
Common symptoms.
- Sharp pain that radiates from the neck into the arm, or from the back into the leg
- Numbness or tingling in the arm, hand, leg, or foot
- Muscle weakness — difficulty gripping objects or walking
- Pain that is worse with sitting, bending forward, coughing, or sneezing
- Neck or back pain at the site of the herniation
- Pain that may be sudden-onset after a specific activity or movement
- Relief when lying flat or walking slowly
- Bowel or bladder dysfunction in severe cases — requires urgent evaluation
What causes it.
- Disc degeneration — the disc becomes less flexible and more prone to tearing with age
- Sudden trauma or injury — a fall, vehicle accident, or awkward lift
- Repetitive physical stress — repeated bending, twisting, or heavy lifting
- Genetic predisposition — herniated discs run in families
- Obesity — excess body weight increases disc stress
- Tobacco use — impairs disc nutrition and accelerates degeneration
- Sedentary lifestyle followed by sudden strenuous activity
When to call us.
Most herniated discs can be managed without surgery. You should seek evaluation promptly if you have significant weakness in your arm or leg, if you have any bowel or bladder symptoms (cauda equina syndrome — a surgical emergency), or if your pain is severe and uncontrolled.
You should consider surgical evaluation if you have had six to twelve weeks of conservative treatment without meaningful improvement, if your neurological symptoms are worsening, or if the quality of your life is significantly affected by ongoing pain.
Dr. Enguidanos will give you an honest assessment of where you stand and what the data says about your specific presentation. He does not recommend surgery before conservative options have been appropriately tried.