Lumbar Disc Herniation (Pinched Nerve)

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 — what most people mean by a "pinched nerve." 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 in people who have 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.

Diagnosis starts with a focused history and a physical exam — strength testing, reflexes, sensation, straight-leg raise. An MRI confirms the level and laterality.

The first chapter is conservative: 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. How long that chapter runs is set by your symptoms and your exam, not by a calendar.

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.

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 an outpatient procedure that removes the fragment pressing on the nerve root. We discuss expectations and recovery realistically before committing.