Herniated disc

The discs between the bones of the spine act as cushions. A herniated disc occurs when some of the soft inner material pushes through the tougher outer layer, where it can press on or irritate a nearby nerve. It is most common in the lower back and the neck.

• Back or neck pain
• Pain that travels down a leg (sciatica) or down an arm
• Numbness or tingling in the leg, foot, arm, or hand
• Weakness in certain muscles
• Pain that is worse with sitting, bending, coughing, or sneezing

Some herniated discs cause no symptoms at all and are found by chance on imaging.

Diagnosis is based on symptoms and an examination of strength, sensation, and reflexes. An MRI is usually reserved for symptoms that do not improve, significant weakness, or when an injection or surgery is being considered.

Many people improve over weeks to months with non-operative care: staying as active as comfort allows, short-term activity changes, medications, and physical therapy. An image-guided epidural steroid injection can help relieve nerve pain for some people.

Surgery may be considered when leg or arm pain remains severe despite non-operative care, or when weakness is getting worse. A common operation in the lower back is a microdiscectomy, which removes the portion of disc pressing on the nerve. In the neck, surgery may involve removing the disc and fusing the bones or placing an artificial disc.