Introduction to symptomatic lumbar disc herniation

Lumbar disc herniation is often asymptomatic; up to 36% of people without a history of back pain have a herniated disc on imaging and this finding increases with age. While lumbar disc herniation can cause spinal nerve root compression, evidence indicates that nerve root compression alone is insufficient to cause symptoms and that inflammation is also important. The prevalence of symptomatic lumbar disc herniation is between 1 and 3%, with the highest prevalence reported in patients between 30 and 50 years of age. Most herniated discs occur at the L4 to L5 level; disc herniations above this level are more common in people over 55 years of age.

In symptomatic lumbar disc herniation, the herniated portion of the disc may regress over time. Most patients who present for care with symptomatic lumbar disc herniation, including lumbar radicular pain (‘sciatica’), improve rapidly (within 2 weeks); 80% of patients recover within 8 weeks and 95% recover within a year. Prognostic factors in symptomatic lumbar disc herniation have not been well studied.

For advice on assessing a person who presents with back pain, see Assessment of back and neck pain.