Dr. Atıf Mutlu

A herniated disc is defined as the disc between the vertebrae protruding outward and putting pressure on the nerve root. The most typical symptom is pain radiating from the waist to the hip and leg. It is common to increase with coughing and straining.

Depending on the degree of pressure, it may be accompanied by numbness, tingling or loss of strength in the leg. During the examination, findings showing the extent to which the nerve root is affected are sought.

Diagnosis is made by history and examination; imaging is used to support these findings. Not every disc protrusion detected on imaging causes a complaint, so if the findings do not match the clinical picture, the treatment is planned according to the patient, not the image.

Low back pain is very common and most resolve within a few weeks. Therefore, not every case of low back pain requires immediate imaging. Early imaging often does not change treatment.

However, some findings require further examination: progressive loss of strength in the legs, deterioration in urinary or stool control, loss of sensation around the anus, fever, unexplained weight loss, previous cancer history, and pain that begins after a significant fall.

If these findings are present, magnetic resonance or tomography is planned. If there is no finding, the priority is pain control, preservation of mobility and, if necessary, physical therapy approaches; imaging comes to the agenda if the complaint persists.

A significant portion of patients with a herniated disc recover without surgery. In the first stage, pain management, appropriate maintenance of daily activity and physical therapy approaches are applied.

Surgery is considered in three main cases: persistent pain despite treatment for a sufficient period of time and restricting daily life, progressive loss of strength in the leg, and the emergence of symptoms affecting urine and stool control. The latter situation requires urgent evaluation.

When making a decision, the imaging findings must be compatible with the examination. Before the surgery, the expected benefits, possible risks and recovery process are discussed in detail.