At a glance
What it is
The gel-like nucleus of an intervertebral disc protrudes through a tear in its fibrous outer ring, often compressing a nerve root.
Typical signs
Sharp pain radiating into an arm or leg (depending on level), with numbness, tingling, or weakness in the same distribution.
How we treat it
Conservative care for most — physiotherapy, medication, targeted injection; surgery only when weakness progresses or pain does not settle.
What a herniated disc is
Intervertebral discs sit between spinal vertebrae, acting as shock absorbers and permitting movement. Each disc has a tough fibrous outer ring (annulus fibrosus) and a soft gel-like core (nucleus pulposus). When the outer ring tears, the core can push outward, forming a herniation.
The herniated fragment often compresses a nerve root as it exits the spine, producing the classic radicular pain pattern — sciatica in the leg from a lumbar disc, radiating arm pain from a cervical disc. The compression can be from mechanical pressure, chemical irritation, or both.
Where herniations occur
The two locations that dominate clinic — cervical and lumbar — present differently because of what each nerve root controls. Thoracic herniations exist but are rare and don't fit the same pattern.
Level A
Lumbar herniation
- Most common at L4/5 and L5/S1.
- Pain radiates down the buttock and leg (sciatica).
- Weakness of ankle dorsiflexion (L5) or plantarflexion (S1) if severe.
Level B
Cervical herniation
- Most common at C5/6 and C6/7.
- Pain radiates from the neck into the arm and hand.
- Weakness of biceps (C5/6) or triceps/wrist extension (C6/7) if severe.
What we see in clinic
90%
Of lumbar herniations improve without surgery within 6–12 weeks
70%
Improve substantially after a single transforaminal epidural injection
5%
Require surgical decompression at first review
Key facts
How it is treated
The plan is stepped and evidence-based. Most patients never leave the first two tiers.
Movement + medication
Weeks 1 to 4
- Stay active; avoid prolonged bed rest
- Simple analgesia + NSAIDs
- Short course of neuropathic-pain medication if nerve pain is severe
Physiotherapy
Weeks 2 to 8
- Postural correction and ergonomic advice
- Nerve gliding, core stability
- Manual therapy as an adjunct
Interventional pain
When conservative care stalls
- Transforaminal epidural steroid injection
- Interlaminar epidural injection for multi-level pain
- Selective nerve root block (diagnostic + therapeutic)
Surgery
Defined indications only
- Microdiscectomy for persistent radicular pain with a matching disc on MRI
- Endoscopic discectomy for suitable single-level herniations
- Cervical discectomy and fusion (ACDF) or artificial disc replacement
- Emergency decompression for cauda equina syndrome
The plan is written and reviewed at 4–6 week intervals; the treatment shifts as symptoms shift.
Related reading
Back pain
Most back pain is mechanical and settles in weeks. The first visit identifies the few cases that need imaging, injections or surgery, without over-treating.
Sciatica
Leg pain along the sciatic nerve, usually from a pinched nerve root. Most cases settle in weeks; the task is spotting those that need targeted treatment.
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about herniated disc and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.