Disc herniations in the lumbar spine are very common. As described above in other disc herniations, the outer capsule of the disc (annular fibrosus) can bulge or even rupture, allowing the softer, inner disc contents (nucleus pulposus) to herniate back into the spinal canal or onto the exiting nerve root. This can cause pain in one or both legs, along with numbness, tingling, and possibly weakness in more severe cases. Back pain may or may not be present.

Sometimes, the symptoms begin after a specific trauma or after heavy lifting. However, oftentimes no such event can be recalled.

Fortunately, most lumbar disc bulges and herniations improve with time and conservative measures. Decompression (DRX) treatments, epidural steroid injections, and physical therapy may alleviate symptoms without surgical intervention.

In those cases where there is no improvement or even worsening of symptoms, surgery is recommended. Likewise, surgery is recommended when there is evidence of weakness.

A small incision is made in the midline of the low back, and the procedure is performed through an operating microscope. A small opening is made in the bone over the spinal canal, and the disc herniation is removed. Additional intervertebral disc is removed as well, and the nerve roots are decompressed. The procedure is called a microdiscectomy.

This procedure is minimally-invasive and patients are mobile soon after surgery. Patients may go home the same day or stay overnight. This technique has been used for generations with a good rate of success. More extensive surgery (lumbar fusion, lumbar disc replacement) is rarely indicated for a first-time disc rupture. These are much bigger procedures that are usually unnecessary in this situation.