When your back hurts, a “slipped disc” is among the first things that come to mind. Yet the great majority of back pain does not arise from a disc herniation.
Most Back Pain Is Not a Disc Herniation
According to the World Health Organization, approximately 90% of back pain is non-specific: the pain cannot be attributed to a single disease or to a particular structural abnormality of the spine. Back pain is also among the leading causes of disability worldwide.
Findings That Suggest a Disc Herniation
In disc herniation, particularly where a nerve root is affected, the pain may not remain confined to the back. The following may be present:
- pain radiating from the buttock down the leg;
- numbness and tingling;
- loss of muscle power in some patients.
This picture is commonly referred to as sciatica.
What Does a Herniation on MRI Mean?
A “herniation” or a disc change seen on MRI does not by itself mean that the cause of the pain has been found.
In a systematic study of people with no back pain at all, disc bulges were present in approximately 30% even at around 20 years of age, rising to 84% by around 80.
In other words, images must always be interpreted together with the patient’s symptoms and the findings of the examination.
When Is Urgent Assessment Required?
If back and leg pain is accompanied by any of the following, you should be assessed without delay:
- new difficulty controlling the bladder or bowel;
- numbness in the genital region or around the anus;
- marked and progressive loss of power.
These findings are uncommon but may indicate serious compression of the nerves.
Surgery Is Not the First Step
In most back pain, surgery is not the first approach. Avoiding unnecessary imaging, maintaining activity and planning conservative treatment suited to the patient are the fundamentals of current guidance.
In short: not every case of back pain is a disc herniation; the patient history and the neurological examination matter more than the MRI image.
For detailed information on the diagnosis, follow-up and surgical treatment of lumbar disc herniation, see the Lumbar Disc Herniation page.
References
- World Health Organization — Low Back Pain Fact Sheet
- NICE — Low Back Pain and Sciatica Guideline
- Brinjikji et al., AJNR, 2015