Lumbar disc herniation, commonly known as a slipped or herniated disc, occurs when the soft inner part of a spinal disc (nucleus pulposus) pushes through its outer layer (annulus fibrosus) and compresses nearby spinal nerves.
It is one of the most common causes of low back and leg pain (sciatica).
Most patients respond well to conservative treatment, but in cases of persistent pain, weakness, or nerve compression, microsurgical decompression offers quick and lasting relief.
Symptoms
Symptoms depend on the affected spinal level, most often L4–L5 or L5–S1, where the nerve roots for the leg and foot are located.
Common symptoms include:
- Low back pain that radiates down the leg (sciatica)
- Numbness or tingling in the leg, calf, or foot
- Leg weakness or foot drop (difficulty lifting the foot)
- Pain worsened by coughing, sneezing, or sitting
- Loss of reflexes in the knee or ankle
- In severe cases: urinary or bowel dysfunction, a sign of cauda equina syndrome — an emergency requiring immediate surgery
Early evaluation is essential to prevent permanent nerve damage.
Diagnosis
Diagnosis begins with a detailed neurological examination and imaging.
- MRI of the lumbar spine is the gold standard for detecting disc herniation and assessing nerve compression.
- CT scan or CT myelography may be used if MRI is contraindicated.
- Electromyography (EMG) can help confirm the level of nerve involvement.
Physical examination tests such as Straight Leg Raise (SLR) are used to reproduce sciatic pain and confirm nerve tension.
Treatment Options
1. Conservative (Non-Surgical) Treatment
- Rest and physiotherapy
- Anti-inflammatory medications and muscle relaxants
- Epidural steroid injections for persistent pain
- Postural training and core-strength exercises to prevent recurrence
Most patients improve within 6–8 weeks without surgery.
2. Microsurgical Discectomy (Microdiscectomy)
For patients with severe or persistent symptoms, microsurgical lumbar discectomy is the gold standard.
Through a small incision, the herniated disc fragment compressing the nerve is removed using a microscope and micro-instruments.
This technique provides immediate pain relief, minimal tissue damage, and a short hospital stay.
3. Endoscopic Discectomy
A minimally invasive alternative performed through a small working channel under local or general anesthesia.
Patients often return to daily life within a few days.
Recovery & Follow-Up
After surgery, patients are usually discharged within 24–48 hours.
Light activities and walking are encouraged early.
Heavy lifting, bending, and twisting should be avoided for 4–6 weeks.
A structured physiotherapy program helps strengthen core muscles and prevent recurrence.
MRI follow-up may be done if symptoms persist or recur.
When to See a Neurosurgeon
If you have severe leg pain, numbness, weakness, or loss of bladder/bowel control, seek medical attention immediately.
Early surgical decompression prevents permanent nerve injury and restores quality of life.