Disc herniation is a common cause of leg and back pain. A disc is composed of two parts: an outer rim of fibrous (tough) tissue surrounding an inner loose material. When there is a break in the outer rim, the inner material can leak out of the disc space and enter the spinal canal where the disc material can compress nerve roots or the spinal cord.
Compression on the nerves can cause sciatica or shooting pain down one or both legs. Back pain can accompany the leg symptoms as well. Furthermore, neurological symptoms such as weakness or numbness in the involved legs may occur.
The pain associated with disc herniation usually improves with lying down and worsens with prolonged sitting/standing or walking. Rarely, bowel or bladder problems and progressive neurological deficits (such as weakness) may develop; this type of situation requires urgent surgical decompression of the nerves under pressure.
A magnetic resonance image (MRI) is an excellent tool to diagnose a herniated disc. If previous surgery has been performed in the area, however, a special MRI with contrast, or a CT myelogram is the most effective way to evaluate the spine. X-rays are also routinely used to determine the bony anatomy and alignment of the spine.
The treatment of a disc herniation is based on the severity and duration of symptoms. Initial treatment is almost always non-surgical. Anti-inflammatory medications, steroids and/or muscle relaxants with rest are initially used to treat the sciatica. Physical therapy can also be very helpful. Most people have full recovery from episodes of sciatica within the first few weeks. If the symptoms continue past 6 weeks, however, one should consider undergoing an evaluation which includes MRI studies. If symptoms continue and conservative management has not been helpful, surgical decompression of the disc (microdiscectomy) may be helpful in relieving the symptoms. The only absolute indications for surgery, however, are progressive neurological symptoms, bowel or bladder problems, and severe, unremitting pain.
