Lumbar Herniated Disc Treatments: Doctor Answers Patient Questions

Peter Ullrich, MD

The following explanations, insights and advice about lumbar herniated discs – including conservative (non-surgical) treatment options - are provided by Peter F. Ullrich, Jr., MD, an orthopedic spine surgeon and Medical Director for Spine-health.

Patients frequently e-mail us questions about their lumbar herniated disc problems, and while we don’t provide individual responses, Dr. Ullrich will periodically take time to respond to the more frequently asked questions which are then published in this section of the site.

Please understand that the following responses to lumbar disc herniation questions represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Lumbar Herniated Disc Treatment Questions and Physician Responses

Question:

I have a herniated disc at L5-S1, causing sciatica down my right leg. I have had some success with physical therapy, but some of the exercises, such as stretching the piriformis muscle, are causing leg pain. Are the piriformis stretching exercises important for healing from the herniated disc?

Doctor’s response:

A lumbar disc herniation can cause tightness in the piriformis muscle, and a tight piriformis muscle can cause leg pain that feels like sciatica, so in many cases it is important to stretch out the piriformis muscle to obtain relief from sciatica. Often the stretching exercises for the piriformis may initially cause more pain. To make sure that you are doing the exercises and stretches correctly it may be helpful to check with an appropriately trained health professional (such as a physical therapist).

If your leg pain persists for three or four months while doing the exercises, conservative care such as exercise may not be sufficient to relieve your pain. If this is the case, I would advise you to be evaluated by a spine surgeon. If there is a great deal of pressure on the nerve root, surgery may help the herniated disc heal faster than additional conservative treatment.

Question:

I have a ruptured disc in my low back and was wondering if this can affect the bladder function as well as sexual performance?

Doctor’s response:

Yes, a ruptured disc (also called a herniated disc) can directly affect the bladder function and cause incontinence - either the inability to hold urine or the inability to empty the bladder. If you have these symptoms you should contact your physician immediately, as these symptoms can indicate a serious medical condition (cauda equina syndrome) and prompt surgical treatment would be needed.

Indirectly, a herniated disc may affect sexual function if you are in a lot of pain. The nerves in the low back that are typically affected by a herniated disc are not directly involved with sexual performance.

Question:

I have a prolapsed disc at L5/S1 that just happened. After a few steroid injections, the leg pain is mostly gone; however there is still numbness in my lower leg and progressive loss of strength in my right leg. Is low back surgery the only way to fix this (I would rather not have surgery), and if I do need surgery, can endoscopic surgery be used to remove the offending part of the disc?

Doctor’s response:

If you are having progressive loss of strength in your leg due to a prolapsed disc (herniated disc), then surgery would be advisable. The surgery can be done either as an endoscopic surgery or as a micro surgery. With an experienced surgeon, both types of surgery can work well. Both are usually equivalent in terms of being minimally invasive and having quick recovery times. However, micro surgery is still probably the gold standard and more surgeons are experienced with microdiscectomy surgery. Endoscopic surgery is generally more difficult and does not provide as good of visualization of the affected nerve root as microsurgery.

I would advise you to consult a spine surgeon (either an orthopedic surgeon or neurosurgeon who specializes in spine surgery) as soon as possible so as not to lose more strength.

Question:

My 19-year-old son had a discectomy surgery a while ago due to a disk herniation at L4-L5. He still has lower back pain, but no leg pain any more. Now we have no diagnosis. He has had MRIs, a bone scan, physical therapy, injections, oral meds and has seen a lot of doctors, but still has no pain relief or answers. We want to get a second opinion, but do not know what type of specialist would be best suited to handle this problem.

Doctor’s response:

If your son has had previous discectomy surgery, then seeing another spine surgeon would be reasonable to check for any surgical pathology. A fellowship trained surgeon (either orthopedic or neurosurgeon) who specializes in spine surgery would probably be best suited to make this type of diagnosis. If a surgical lesion is ruled out, then the only other option is rehabilitation for the low back, and this is often best done with a rehabilitation doctor (a physiatrist, also called a Physical Medicine and Rehabilitation specialist) who specializes in treating back pain.

What next?

If you have questions about lumbar disc herniation, please use this site to find peer-reviewed health information about spinal conditions, diagnosis and treatment options. The quickest way to locate information on the site is to use the “keyword search” box located in the upper left hand corner of each page. Also, if you want to talk online with others who may be in a similar situation or exchange information with other patients with a lumbar herniated disc, please go to the Spine Forum Message Boards.

Additional disclaimer: Spine-health does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as one physician's opinion based on an extremely limited amount of information. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health’s Medical Advisory Board.