Lumbar disc herniation

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: Lumbar intervertebral disk herniation (herniated disk) is a condition in which the nucleus pulposus at the center of an intervertebral disk protrudes posteriorly or posterolaterally due to damage or degeneration of the surrounding annulus fibrosus, compressing adjacent nerve roots or intervertebral foramina and causing symptoms. Disk degeneration (loss of water and reduced elasticity) and traumatic overload act together.
• Main causes: Degenerative changes in the disk, suddenly lifting heavy objects or adopting an abnormal posture, smoking, and age (increased incidence), among others. Occupational factors (such as repetitive bending and lifting) are reported as risk factors.
• Main symptoms:
  • Low back pain and buttock pain
  • Radiating pain along the distribution of a single nerve root (numbness and pain extending down to the thigh, calf, dorsum of the foot, or sole)
  • Sensory loss and muscle weakness (such as paralysis of the toes or ankle)
  • In severe cases, bowel or bladder dysfunction and saddle-area sensory loss (cauda equina syndrome) — an emergency

Treatment Methods

• Conservative treatment (improvement within 4–12 weeks in most patients)
  • Activity modification: During the acute phase, short-term rest and pain relief followed by a gradual return to activity. Long-term bed rest is not recommended.
  • Medication: NSAIDs, short-term muscle relaxants, medications for neuropathic pain (gabapentin and pregabalin), and, when necessary, short-term oral corticosteroids (selectively); short-term opioids may be considered if the pain is severe.
  • Physical therapy and exercise therapy: Focused on functional recovery, including pelvic traction, heat and electrotherapy, core strengthening, and stretching.
  • Spinal injection treatment: Nerve root block (epidural steroid injection) — for failure of conservative treatment or relief of radicular pain.
  • Use of a brace: For short-term pain control. Be aware that long-term use may weaken the back muscles.
• Surgical treatment
  • Indications: Progressive or severe neurological paralysis (muscle weakness), bowel or bladder dysfunction (cauda equina), or pain so severe despite conservative treatment that daily activities are impossible.
  • Representative procedures: Microscopic diskectomy (microdiskectomy) and minimally invasive endoscopic disk removal.
  • Postoperative plan: Early ambulation is recommended, and rehabilitation treatment (to restore strength and flexibility) is necessary.
• Points to note during treatment
  • For new surgical or treatment methods, it is necessary to confirm that long-term safety and efficacy have been established.
  • Long-term use of a brace may cause muscle weakness — physical therapy is recommended concurrently.
  • Smoking adversely affects disk healing and surgical outcomes — smoking cessation is recommended.

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Items to bring
  • A list of medications currently being taken (including prescription drugs, over-the-counter medications, and supplements)
  • Previous test results and reports (if previous MRI, CT, or X-ray images are available, bring printed copies or electronic files)
  • Records of previous surgeries, hospitalizations, or other spine-related treatments
  • Symptom record: onset, characteristics of pain (location, intensity, and whether it radiates), factors that worsen or improve it, presence of paralysis or sensory loss, and changes in bowel or bladder function
  • Information about daily life (occupation and exercise habits) and smoking and alcohol use
• Materials to show the doctor during the outpatient visit
  • Recent images (MRI preferred), medication list, and symptom diary (especially whether there is muscle weakness, sensory loss, or bowel or bladder dysfunction)
• Self-check before the outpatient visit (symptoms that must be reported immediately)
  • Sudden muscle weakness (unable to walk or lift the foot)
  • Abnormal bowel or bladder function or loss of sensation in the saddle/perineal area
  • Severe sensory abnormalities or paralysis in both legs → If these symptoms occur, emergency consultation or a visit to the emergency department is recommended

Examples of General Questions to Ask the Doctor

• What are the main side effects of this medication (or injection), and how long are they expected to last?
• How long should I be observed with conservative treatment before considering surgery?
• When can I resume daily activities (exercise, returning to work, driving, etc.)?
• If surgery is recommended, what surgical method would be used, what is the expected recovery time, and how significant is the risk of complications?
• What lifestyle changes or exercise programs can reduce the risk of recurrence?

Examples of Condition-Specific Questions

• My leg is becoming weak (for example, it is difficult to lift the top of my foot). Does this mean I need to have surgery soon?
• I have some changes in bowel or bladder function (or I feel decreased sensation in the saddle area). How can I determine whether this symptom is a serious emergency sign?