What is a Herniated Disc?

A herniated disc, also called a herniated disk, slipped disc, ruptured disc, or herniated nucleus pulposus, occurs when the inner portion of a spinal disc pushes through or out of the outer disc layer. Spinal discs sit between the vertebrae and help cushion the spine.

A herniated disc can occur in the cervical spine in the neck, the thoracic spine in the mid back, or the lumbar spine in the lower back. Some herniated discs cause no symptoms. Others may irritate or compress a nearby nerve root, causing radiculopathy, which can lead to radiating arm or leg pain, numbness, tingling, or weakness.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed herniated discs when symptoms suggest nerve compression, spinal cord compression, cervical radiculopathy, lumbar radiculopathy, sciatica, spinal stenosis, or another spine-related condition that may require neurosurgical review.

Common Signs and Symptoms

Herniated disc symptoms depend on the location of the disc herniation, the size of the herniation, and whether a nerve root or the spinal cord is compressed.

Common signs and symptoms may include:

• Neck pain, mid back pain, or low back pain
• Pain that travels into the shoulder, arm, hand, or fingers when the herniated disc is in the neck
• Pain that travels into the buttock, hip, thigh, calf, or foot when the herniated disc is in the lower back
• Sciatica, meaning radiating leg pain along the sciatic nerve pathway
• Sharp, burning, shooting, or electric-like pain
• Numbness or tingling in the arm, hand, leg, or foot
• Pins-and-needles sensation
• Weakness in the arm, hand, leg, ankle, or foot
• Reduced grip strength when a cervical nerve root is affected
• Foot drop or difficulty lifting the front of the foot in selected lumbar disc herniations
• Pain that worsens with sitting, bending, lifting, coughing, sneezing, or certain movements
• Balance problems, trouble walking, or loss of hand coordination when spinal cord compression is present

Seek urgent medical evaluation for progressive weakness, foot drop, worsening numbness, balance problems, trouble walking, loss of hand coordination, numbness in the groin or saddle area, new bowel or bladder problems, fever, unexplained weight loss, history of cancer, severe pain after trauma, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for symptoms concerning for cauda equina syndrome, spinal cord compression, stroke, or another emergency condition.

What Causes This Condition?

A herniated disc can occur when the outer disc layer weakens or tears, allowing inner disc material to move outward. This may happen gradually from degeneration or suddenly after injury or strain.

Possible causes and related factors may include:

• Disc degeneration, meaning age-related wear and loss of disc strength
• Annular tear, a tear in the outer disc layer
• Lifting, bending, twisting, or sudden movement
• Repetitive spine stress or overuse
• Trauma, fall, sports injury, or motor vehicle accident
• Poor lifting mechanics or heavy physical work
• Smoking, which may affect disc health in some patients
• Excess body weight, which may increase stress on the spine
• Genetic or family tendency toward disc degeneration in some patients
• Prior disc herniation or spine surgery in selected cases
• Degenerative spine conditions such as spinal stenosis, spondylosis, or facet joint disease

These causes and risk factors do not mean every patient with a herniated disc will have symptoms. Treatment planning depends on symptom severity, neurological examination, imaging findings, nerve compression, spinal cord involvement, response to prior care, and overall health.

How It Is Diagnosed?

A herniated disc is diagnosed through medical history, physical examination, neurological examination, and imaging when appropriate. Imaging findings must be compared with symptoms because some disc herniations are found incidentally and do not cause pain.

Common diagnostic steps may include:

• Medical history and symptom review to understand neck pain, back pain, arm pain, leg pain, numbness, tingling, weakness, triggers, injury history, and prior treatment
• Physical examination to evaluate posture, range of motion, tenderness, muscle spasm, walking pattern, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root or spinal cord involvement
• Straight leg raise testing when lumbar disc herniation or sciatica is suspected
• Spurling test or other cervical nerve provocation maneuvers when cervical radiculopathy is suspected
• X-rays of the spine to evaluate alignment, arthritis, disc space narrowing, instability, fracture, or degenerative change, although X-rays do not directly show a herniated disc
• MRI of the cervical, thoracic, or lumbar spine to evaluate disc herniation, nerve root compression, spinal cord compression, spinal stenosis, tumor, infection, or other soft-tissue findings
• CT scan when bone detail, fracture, arthritis, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may overlap with peripheral neuropathy, carpal tunnel syndrome, ulnar neuropathy, peroneal neuropathy, or another nerve disorder
• Blood tests in selected cases when infection, inflammatory disease, cancer-related concern, or another medical condition is suspected

The goal of diagnosis is to determine whether the herniated disc is actually causing symptoms, identify the affected nerve or spinal cord area, and decide whether conservative care, injections, or surgical evaluation may be appropriate.

Treatment Options

Herniated disc treatment depends on the location of the disc herniation, severity of symptoms, neurological examination, imaging findings, spinal cord involvement, prior treatment, activity limitations, and overall health. Many patients begin with non-surgical care when there is no progressive neurological deficit, cauda equina syndrome, spinal cord compression, fracture, infection, tumor, or other urgent concern.

Treatment options may include:

• Activity modification to reduce positions, lifting, bending, twisting, or movements that worsen symptoms
• Physical therapy to improve posture, mobility, strength, flexibility, nerve-related symptoms, and safe movement mechanics
• Home exercise and stretching when recommended by a clinician or therapist
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Treatment of posture, ergonomic, or activity-related contributors
• Cervical or lumbar epidural steroid injection in selected cases involving nerve root inflammation or radiating arm or leg pain
• Selective nerve root block in selected cases when diagnostic or therapeutic nerve-targeted injection is appropriate
• Microdiscectomy in selected lumbar disc herniations with persistent or progressive nerve compression symptoms
• Endoscopic discectomy in selected lumbar disc herniations when anatomy and symptoms support that approach
• Lumbar laminectomy, laminotomy, or foraminotomy in selected cases when additional decompression is needed
• Anterior cervical discectomy and fusion, also called ACDF, in selected cervical disc herniations causing nerve compression, spinal cord compression, or instability
• Cervical disc replacement in selected patients with appropriate anatomy and cervical disc-related nerve compression
• Posterior cervical foraminotomy in selected cases when nerve root compression can be addressed from the back of the neck
• Thoracic disc surgery in selected thoracic disc herniations involving significant nerve compression, spinal cord compression, or neurological symptoms
• Lumbar fusion or cervical fusion in selected cases involving instability, deformity, recurrent disc herniation, or other structural concerns
• Rehabilitation and follow-up care to monitor pain, strength, sensation, walking, function, and nerve recovery

Surgery is not appropriate for every herniated disc. Neurosurgical treatment may be considered when a herniated disc causes significant nerve compression, progressive weakness, spinal cord compression, cauda equina symptoms, persistent radiculopathy, or symptoms that do not improve with appropriate non-surgical care.