Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain (sciatica).
Between 60 and 80 percent of people will experience low back pain at some point in their lives. A high percentage of people will have low back pain caused by a herniated disk.
Although a herniated disk can sometimes be very painful, most people feel much better with just a few months of nonsurgical treatment.
Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.
Five vertebrae make up the lower back. This area is called your lumbar spine.
Other parts of your spine include:
Intervertebral disks are flat and round, and about a half inch thick. They are made up of two components:
A disk begins to herniate when its jelly-like nucleus pushes against its outer ring due to wear and tear or a sudden injury. This pressure against the outer ring causes lower back pain.
If the disk is very worn or injured, the jelly-like center may squeeze all the way through.
Once the nucleus breaks or herniates through the outer ring, pain in the lower back improves. Sciatic leg pain, however, increases. This is because the jelly-like material inflames the spinal nerves. It may also put pressure on these sensitive spinal nerves, causing pain, numbness, or weakness in one or both legs.
In many cases, a herniated disk is related to the natural aging of your spine.
In children and young adults, disks have a high water content. As we get older, our disks begin to dry out and weaken. The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process is called disk degeneration.In addition to the gradual wear and tear that comes with aging, other factors can increase the likelihood of a herniated disk. Knowing what puts you at risk for a herniated disk can help you prevent further problems.
For most people with a herniated disk, low back pain is the initial symptom. This pain may last for a few days, then improve. It is often followed by the eventual onset of leg pain, numbness, or weakness. This leg pain typically involves the leg below the knee, and foot and ankle. It is described as moving from the back or buttock down the leg into the foot.
Symptoms may be one or all of the following:
To determine whether you have a herniated lumbar disk, your doctor will ask you for a complete medical history and conduct a physical examination. The diagnosis can be confirmed by a magnetic resonance imaging (MRI) scan.
Medical History and Physical Examination
After discussing your symptoms and medical history, your doctor will examine your spine. During the physical examination, your doctor may conduct the following tests to help determine the cause of your low back pain.
To help confirm a diagnosis of herniated disk, your doctor may recommend a magnetic resonance imaging (MRI) scan. This scan can create clear images of soft tissues like intervertebral disks.
In the majority of cases, a herniated lumbar disk will slowly improve within 6 to 8 weeks. By 3 to 4 months, most patients are free of symptoms.
Unless there are neurological deficits muscle weakness, difficulty walking or cauda equina syndrome, conservative care is the first course of treatment. It is not clear, however, that nonsurgical care is any better than letting the condition resolve on its own.
Common nonsurgical measures include:
Of the above measures, only epidural injections have been proven effective at reducing symptoms. There is good evidence that epidural injections can be successful in 42-56% of patients who have not been helped by 6 weeks or more of other nonsurgical care.
Overall, the most effective nonsurgical care for lumbar herniated disk includes observation and an epidural steroid injection for short-term pain relief.
A small percentage of patients with lumbar disk herniations require surgery. This includes the urgent surgeries for people with neurological deficits or cauda equina syndrome.
Surgery for lumbar herniated disk is controversial. Research shows that patients 2 years post-surgery have the same results as patients treated nonsurgically. Patients with significant sciatica who have surgery, however, have better and more rapid pain relief. Surgery resolves symptoms faster for those with motor weakness or numbness, as well.
Regardless of the kind of treatment prescribed, there is a 5% chance of the disk herniating again.
The risk of nonsurgical treatment is that your symptoms may take a long time to resolve. If after 6 months or so you elect to have surgery, the final outcome may not be as good as if you had elected surgery earlier.
The risk of surgical complications is exceptionally low. Possible complications include:
Patients who opt for nonsurgical care can return to their normal activities as soon as their pain is manageable.
About 95% of the patients who have surgery experience dramatic pain relief immediately after surgery. Most patients can return to their normal daily activities within 1 to 2 weeks after surgery.
Last reviewed and updated: February 2009
AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.