Lumbar Spine
Lumbar Disc Herniation
Most disc herniations improve without surgery. The decision is rarely just "is there a herniation" — it is whether your symptoms match the imaging and how much function you have lost.
What it is
A lumbar disc herniation occurs when the soft inner core of a spinal disc pushes through its outer ring and contacts a nerve root in the lower back. The nerve compression — not the bulge itself — is what causes the radiating pain, numbness, or weakness that travels into the buttock or leg.
Imaging picks up disc herniations frequently, including in people with no symptoms at all. The clinical decision is matching what your MRI shows to what your body is actually doing on exam. A finding on MRI without a matching exam is rarely a reason to operate.
How we approach it
Diagnosis starts with a focused history and a physical exam — strength testing, reflexes, sensation, straight-leg raise. An MRI confirms the level and laterality.
Most patients improve with time, physical therapy, and a brief course of anti-inflammatories. An epidural steroid injection can buy time and reduce inflammation if the pain is severe. Six to twelve weeks of conservative care is a typical first chapter.
I review your imaging with you and explain exactly what we are seeing — including findings that are not the source of your pain. Decisions are made together.
When surgery is considered
Surgery becomes the right answer when leg pain is unresponsive to conservative care, when there is progressive weakness, or in the rare emergency of cauda equina syndrome (loss of bowel or bladder control, saddle numbness — call 911).
For the right patient, a microdiscectomy is a high-success outpatient procedure with a quick recovery. We discuss expectations and recovery realistically before committing.
Common symptoms
- Sharp, electric-feeling pain shooting down one leg (sciatica)
- Weakness in the foot or ankle (foot drop, calf weakness)
- Numbness or tingling along a specific nerve distribution
- Pain worse with sitting, coughing, sneezing, or bending forward
- Loss of bowel or bladder control — emergency, call 911
Non-surgical options we consider first
- Physical therapy focused on core stabilization and nerve gliding
- Anti-inflammatory medication
- Epidural steroid injection (image-guided)
- Activity modification and time — most herniations improve over 6–12 weeks
Related procedures
If surgery is the right next step, the most common procedures for this condition are:
Videos for this condition
- Preparing for Your Spine Surgery (Ages 50–65)(in production · 9 min)
- Lumbar Microdiscectomy(in production · 6 min)
Last reviewed: 2026-05-09· Author: Chad Tuchek, MD · Cotton O'Neil Neurosurgery and Spine Center, Stormont Vail Health
The information on this page is general patient education and is not a substitute for individualized medical advice. For urgent symptoms, call 911 or go to the nearest emergency department. For non-urgent questions, call (785) 368-0767.