Lumbar disc herniation

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What is a lumbar disc herniation?

Between each vertebra lies an intervertebral disc — a cushion-like shock absorber made of a tough fibrous ring surrounding a soft, gel-like core. When this ring tears, part of the core can escape and press on a nearby nerve: this is a disc herniation.

Herniations most commonly occur between the L4-L5 and L5-S1 vertebrae, right at the base of the lumbar spine where mechanical stresses are greatest. Depending on which nerve is affected, the pain "travels" down the leg along a precise path — this is known as sciatica (back of the thigh and calf) or cruralgia (front of the thigh).

How it develops

A disc does not rupture overnight. It is usually the end result of a gradual process:

• Disc wear: over the years, the disc loses water, becomes less supple and more vulnerable
• Mechanical overload: heavy lifting, repetitive movements, prolonged positions (sitting, bending forward)
• Triggering event: a sudden effort, an awkward twist or sometimes a simple sneeze can cause the final tear
• Predisposing factors: excess weight, smoking (which weakens discs) and a sedentary lifestyle all increase the risk

Symptoms & Clinical signs

The clinical picture depends on which nerve is compressed and how severe the compression is:

• Radicular pain: intense pain radiating down the leg, often described as a "burning" sensation or an "electric shock" along the nerve pathway
• Low back pain: pain in the lower back, sometimes present for weeks or months before the acute episode
• Sensory disturbance: tingling, numbness or a feeling of "cardboard skin" in the foot or leg
• Weakness: difficulty walking on the heels or on tiptoe — a sign of motor impairment that should be reported urgently
• Cauda equina syndrome: urinary problems or perineal numbness — an absolute surgical emergency

Diagnosis

• Clinical examination: the Lasègue test (straight leg raise) reproduces the pain; assessment of sensory or motor deficit
• Lumbar MRI (gold standard): visualises the herniation, its size, position and degree of nerve compression
• CT scan: complementary, useful for detailing bony structures before potential surgery
• EMG: if in doubt, it measures nerve suffering and identifies the affected root

Treatment

The good news: the vast majority of disc herniations heal without surgery. Time and well-managed treatment are enough in most cases:

Conservative treatment (first line)

• Relative rest (avoid strict bed rest), gradual return to activity
• Painkillers and anti-inflammatory drugs to control acute pain
• Physiotherapy once the inflammatory phase has subsided
• Epidural steroid injections: effective at "calming" the inflammation around the nerve

Surgical treatment (discectomy)

• Indications: failure of medical treatment after 6 to 8 weeks, persistent disabling pain, or neurological deficit (weakness, cauda equina syndrome)
• Technique: removal of the herniated disc fragment through a 2–3 cm incision, under microscope or surgical loupe
• Outcome: rapid relief in over 85% of cases; return to normal activities within a few weeks

Key figures

Recovery after surgery

After a lumbar discectomy performed by Dr Dimitriu, recovery follows a well-established and reassuring timeline:

• Day of surgery: getting up is encouraged the same evening. The leg pain (sciatica) is often relieved immediately — patients frequently describe this as dramatic relief
• Hospital stay: 1 to 2 nights on average. Appropriate pain medication is prescribed for the first few days
• First weeks: daily walking is the best exercise. Prolonged sitting, heavy lifting and long car journeys should be avoided
• 4 to 6 weeks: gradual return to daily activities. Physiotherapy begins with lumbar muscle strengthening exercises
• 3 to 6 months: progressive return to sport. Swimming and cycling are permitted first, impact sports last
• Time off work: varies by occupation — 3 to 4 weeks for office work, 6 to 12 weeks for physical jobs

Consultation with Dr Dimitriu

During the initial consultation, Dr Dimitriu performs a thorough clinical examination: the Lasègue test, assessment of muscle strength, reflexes and sensation. He then reviews your imaging studies (MRI, CT scan) to determine the exact size and location of the herniation.

Dr Dimitriu always favours conservative treatment first. Surgery is only proposed when truly necessary: pain resistant to treatment, motor deficit or cauda equina syndrome. Each patient receives a personalised treatment plan, explained in detail, with close follow-up through to full recovery.

Prevention

A few simple measures significantly reduce the risk of disc herniation or recurrence:

• Muscle strengthening: core exercises and lumbar stabilisation create a natural "muscle corset" that protects the discs
• Posture: keep the back straight when sitting, use an ergonomic chair, stand up regularly
• Lifting technique: bend the knees and keep the load close to the body, never lift with a twisting motion
• Healthy weight: every extra kilogram increases the pressure on the lumbar discs
• Stop smoking: smoking accelerates disc degeneration by reducing blood supply to the discs

Consultations in Île-de-France

Dr Dimitriu practises at 4 facilities in the Paris region (Île-de-France), easily accessible from central Paris: Clinique de l'Yvette (Longjumeau), Hôpital Privé d'Antony, Clinique du Mont-Louis (Les Lilas) and Hôpital Privé de l'Ouest Parisien (Saint-Cloud). See addresses and book an appointment.

Frequently asked questions

Sources: Haute Autorité de Santé (HAS) · SFCR · The Lancet (Ropper & Zafonte, 2015).