The lower back contains five vertebrae, separated by discs that act as shock absorbers and help the spine move. A lumbar herniated disc occurs when part of a disc bulges or pushes out of its normal position. The displaced disc material can narrow the spinal canal and press on a nerve root, causing severe pain in the lower back that may radiate into the leg.
Herniated Disc Treatment
A common problem in herniated disc treatment is assessing the patient from the perspective of only one medical specialty. This can limit the available options. Some patients who could recover without surgery may undergo an unnecessary herniated disc operation, while patients who genuinely need surgery may lose valuable time trying other treatments and could develop irreversible problems. A balanced assessment should therefore consider both surgical and non-surgical options.
Appointments & practical information
How do I book an appointment?
You can send your appointment request via WhatsApp, by phone or through the contact form. Briefly describing your complaint and the times that suit you speeds things up; we respond as quickly as possible.
What should you bring to the consultation?
If available, bring your recent MRI and CT images, previous test and surgery reports, and a list of the medication you take regularly. This makes the assessment considerably easier.
What happens at the first consultation?
We listen to your complaints and history, perform a neurological examination and review your existing images together. Treatment options are then planned with you, taking your expectations and lifestyle into account.
Second opinion
If you have been diagnosed or advised to have surgery elsewhere, you can book an appointment for a second opinion with your existing images and reports.
Reach out for your questions and appointment requests. We reply as soon as possible.
Diagnosing a herniated disc is a process in which the surgeon's clinical experience is combined with modern technological possibilities. The first and most important step is to listen to the patient's complaints and to perform a detailed neurological examination. In this examination, muscle strength, reflexes and sensory losses are carefully assessed. Then, with the gold-standard high-resolution lumbar MRI (Magnetic Resonance Imaging), the location and size of the herniation and the degree of pressure it exerts on the nerve are clarified. Computed Tomography (CT) to examine the bone structure, or an EMG test to measure the conduction velocity of the nerves, are also elements that complete the diagnostic process.
Is Every Low Back Pain a Herniated Disc?
Contrary to the general belief in society, not every low back pain is a herniated disc. About 90% of low back pain is caused by muscle strains, connective tissue injuries, facet joint arthritis (calcification) or mechanical overloading. Among these causes of pain, a herniated disc is a more specific condition characterized by nerve compression. For this reason, treatments applied without a correct diagnosis can lead to a waste of time.
Is a Herniated Disc a Genetic Disease?
Although a herniated disc does not directly fall into the category of a "hereditary" disease, a familial predisposition is an important factor. If a person's mother or father had a herniated disc at a young age, it is likely that the collagen tissue in that person's disc structure is weak. When this is combined with environmental factors (heavy lifting, weight, etc.), it increases the risk of developing a herniation.
I Have Pain and Numbness Radiating to My Leg, Could This Be a Sign of a Herniated Disc?
Yes, this is the most typical and warning sign of a herniated disc. When the herniated disc in the lower back presses on the nerve roots going to the leg (usually the sciatic nerve), the pain is felt in the leg, the hip or the toes rather than in the lower back. If this pain is also accompanied by numbness and tingling, it is a sign that the nerve root is under serious pressure.
What Does a Ruptured (Extruded) Herniated Disc Mean?
A ruptured herniation, called an "Extruded Disc" in the medical literature, is the tearing of the protective hard outer layer of the disc (annulus fibrosus) and the leaking of the soft, jelly-like tissue inside it (nucleus pulposus) into the spinal canal. Because this leaking fragment directly compresses the nerves, it usually leads to suddenly starting, severe and unbearable pain.
What Does a Sequestered Herniated Disc Mean?
A sequestered herniation is the most advanced stage of a herniated disc. In this condition, a fragment broken off from the main disc has become completely free within the spinal canal and has migrated upward or downward. Because these free fragments put uncontrolled pressure on the nerve roots, this is the group that must be followed most carefully with surgery in terms of the risk of sudden paralysis or severe neurological losses.
What Are the Symptoms of a Herniated Disc?
The most common symptoms are: sharp pain that starts in the lower back and spreads to the leg, numbness/tingling in the leg and foot, a shortened walking distance and difficulty standing. In more serious cases, symptoms requiring urgent intervention are seen, such as weakness in the leg muscles, foot drop (the foot catching while walking), and impaired control of urination and defecation.
What Causes a Herniated Disc?
A herniated disc usually results from a combination of several factors. The primary causes of herniation are the loss of water in the discs due to aging (degeneration), being overweight, uncontrolled heavy lifting, sitting motionless for long periods, smoking (which impairs the nutrition of the disc) and sudden awkward movements.
Does a Herniated Disc Cause Leg Pain?
Yes, the characteristic feature of a herniated disc is leg pain. The vast majority of patients come with the complaint, "My lower back doesn't hurt much, but it feels like my leg is being torn off." The reason for this is that the nerve compression in the lower back reflects the pain to the leg region where the nerve is distributed.
Does a Herniated Disc Cause Numbness and Loss of Sensation in the Feet?
It definitely does. When the pressure of the herniation on the nerve continues, the nerve fibers become unable to conduct properly. While this initially creates a sensation of tingling and burning, as the pressure increases it can turn into a "pins and needles" feeling (deadening) and complete loss of sensation in the foot.
Can a Herniated Disc Cause Urinary Incontinence?
Yes, and this condition is regarded in neurosurgery as a "Red Alert" (Cauda Equina Syndrome). If the herniation compresses the bundle of nerves at the lower end of the spinal canal, the patient may be unable to hold their urine or stool, or may be unable to pass them. It is vitally important for a patient who develops this picture to go to the emergency department without wasting time.
Does Every Herniated Disc Require Surgery?
No, about 90-95% of patients with a herniated disc can recover with non-surgical methods. In modern medicine, surgery is applied only in "selected" patients who are at risk of paralysis, whose urinary/bowel control is impaired, or whose pain does not go away despite 6 weeks of other treatments.
Does a Ruptured Herniated Disc Require Emergency Surgery?
Although the term "ruptured herniation" frightens patients, not every ruptured herniation means emergency surgery. If the patient has not developed a serious loss of strength (paralysis), this process can also be managed without surgery, with injection treatments (epidural injections) that suppress the edema the herniation creates around the nerve, or with rest.
Is Ozone Used in the Treatment of a Herniated Disc?
Ozone therapy is an effective complementary method, especially in early- and moderate-level herniations. The ozone gas injected into the disc helps to reduce the volume of the herniated tissue and relieves the nerve by reducing the inflammation in the area.
What Is Laser Treatment for a Herniated Disc and How Is It Performed?
Laser treatment is the procedure of reducing the internal pressure of the disc by entering the center of the disc through a needle and delivering laser energy. This method does not require a surgical incision. However, the laser is not suitable for every type of herniation; it is generally preferred in cases that have not yet ruptured (contained) and where the outer wall of the disc is intact.
What Are the Injection Treatments for a Herniated Disc?
These are grouped under the heading of interventional pain treatments. The most common are: transforaminal injections applied directly to the nerve root, epidural injections applied around the spinal membrane (dura), nucleoplasty and facet joint blocks. These injections rapidly relieve the edema and inflammation in the herniation area, increase the patient's comfort and can eliminate the need for surgery.
What Happens If a Herniated Disc Is Not Treated?
Untreated herniations with ongoing nerve compression can cause permanent wasting (atrophy) of the leg muscles, foot drop and chronic neuropathic pain. In the worst-case scenario, nerve conduction can be completely cut off, resulting in irreversible paralysis.
Which Doctor Should Be Consulted for the Treatment of a Herniated Disc?
The main specialty specialized in the diagnosis, follow-up and both the surgical and interventional (injection) treatments of a herniated disc is Neurosurgery.
Is Swimming Good for a Herniated Disc?
Absolutely yes. Thanks to the buoyancy of the water, swimming reduces the load on the spine to zero. Backstroke swimming in particular strengthens the back and abdominal muscles in the safest way, making a great contribution to the healing of the herniation and the prevention of recurrences.
Which Conditions in a Herniated Disc Require Urgent Intervention?
Foot drop (sudden loss of strength), inability to pass or incontinence of urine or stool, sexual dysfunction, and severe pain that does not subside despite all treatments and does not let the patient sleep require emergency surgical intervention.
Which Method Should Be Preferred and When in a Herniated Disc?
In mild herniations, medication and physical therapy should be preferred; in resistant pain that does not go away with this method, interventional injections or nucleoplasty; and in cases of neurological loss (risk of paralysis) or severe ruptured herniations unresponsive to treatment, microsurgery should be preferred.
Does Physical Therapy Completely Cure a Herniated Disc, or Does It Only Relieve the Pain?
Physical therapy strengthens the lower back muscles, thereby reducing the load placed on the disc. In small and moderate herniations, it can provide lasting recovery. However, in large herniations that severely compress the nerve, even if it relieves the pain, it may not completely eliminate the herniation; for this reason, it should be supported with interventional methods.
What Are the Definitive Criteria That Lead to the Decision for Surgery in a Herniated Disc?
The decision for surgery is made if one of the following four main criteria is present: 1. Progressive loss of strength, such as foot drop. 2. Loss of bladder/bowel control. 3. Severe pain that does not resolve despite at least 6 weeks of other treatments. 4. A loss of quality of life that makes daily life impossible.
What Lifestyle Changes Should Be Made to Protect Back Health After Treatment?
Regular back and abdominal exercises should be done, smoking should be quit (smoking impairs the nourishment of the disc), one should not sit in the same position for long periods, and objects should be lifted by bending the knees rather than from the back.
What Are the Risks of Folk Practices Used in Treating a Herniated Disc, Such as Back Manipulation, Cupping, and Similar Methods?
Such unscientific methods can lead to the rupture of the nerve root, cause paralysis by making a non-ruptured herniation drop into the canal, or result in permanent disabilities. Spinal health should be entrusted only to physicians who are specialists in the field.
If a Herniated Disc Is Left Untreated, Can It Cause Problems Such as Urinary Incontinence?
Yes. The chronic pressure of the herniation on the nerves can damage the autonomic nerve fibers that control the bladder and bowel. This situation can lead to serious consequences such as permanent urinary incontinence or loss of erection.
Is Losing Weight a Part of Herniated Disc Treatment?
Absolutely yes. Our lumbar vertebrae are the center of body weight. Every kilogram lost reduces the pressure on the herniated disc, thereby accelerating the healing process and ensuring the durability of the treatment.
At Which Stage of Herniation Do Medication and Rest Treatment Give Results?
In early- and moderate-level neck (cervical) herniations that have just begun and have not caused nerve damage, medication and rest usually provide sufficient recovery within 2-4 weeks.
Why Does a Treated Herniated Disc Recur, and What Should Be Done to Prevent Recurrence?
A herniation recurs because of the weakness of the disc tissue and the excessive load placed on it. To prevent recurrence, one must move away from the "herniation-causing lifestyle". That is, weight should be lost, the lower back or neck muscles should be strengthened, and habits of carrying heavy loads should be abandoned.
