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More properly called a herniated nucleus pulposus since it is the gelatinous inner disc material, the nucleus pulposus, which ruptures through the outer disc wall. All humans undergo tremendous stresses on their spines each and every day. We often lift things too heavy or in an awkward position. The spinal discs act as cushions between the vertebral bodies and occasionally stresses exerted on the disc exceed the wall strength and the inner portion of the disc will rupture or herniate through. As a disc begins to wear out, there may be some prior midline low back pain which then may become radiating pain, from the disc herniation, into the buttocks or legs depending on the level of the disc involved. This comes from material within the disc pressing on the nerve roots which cause pain into the extremities. Sometimes there will be no back pain or minimal pain in the back. The primary complaint will be pain into the buttock or leg often referred to as sciatic pain.
Disc herniation is usually seen in 30- to 50-year-old individuals. It is sometimes seen in individuals in their 80s but this is very rare as normal aging tends to dry out the disc preventing rupture of any fragments. Infrequently adolescents in their early teens will have herniations. These are rare and generally have a worse prognosis for long term back and disc health.
Most often milder radiating leg pain will go away in time on its own. However, larger disc fragments may cause extraordinary pain sometimes with motor weakness and sensory loss. In rare cases a fragment may impinge on the sacral roots and loss of bowel and bladder function can ensue. This is one of the few surgical emergencies in that quick decompression of the nerve roots involving the sacrum is the best way to minimize permanent incontinence issues. Disc herniations in themselves are not emergencies and individuals may be left with weakness or numbness in spite of surgical decompression.
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