What it is
A lumbar disc sits between two vertebrae and acts as a spacer and a shock absorber. When the tough outer ring tears, softer material from the center can push out and press on a nerve root heading down into the leg. The result is sciatica — leg pain that usually outweighs the back pain.
Symptoms
- Sharp or burning pain traveling into the buttock, thigh, calf or foot
- Numbness or tingling in a specific band of the leg or foot
- Weakness — a foot that drops, difficulty rising onto the toes
- Pain worse with sitting, coughing or sneezing
How it is diagnosed
The examination maps the symptoms to a nerve root: L5 affects the top of the foot and the ability to lift it; S1 affects the sole and the push-off. A straight leg raise that reproduces the leg pain supports the diagnosis. MRI confirms the level and the size of the fragment.
Non-surgical treatment
The natural history is genuinely favorable. Most people improve within three months with activity modification, physical therapy, anti-inflammatory medication, and in some cases a nerve root or epidural injection. Bed rest is not helpful; staying as active as the pain allows is.
When surgery is considered
Persistent, disabling leg pain after six to twelve weeks of good non-operative care; progressive weakness; or cauda equina syndrome, which is an emergency. A discectomy to remove the offending fragment is a reliable operation for leg pain, usually done through a small incision with a short recovery.