Herniated Disc
A herniated intervertebral disc is one of the most common spinal conditions and is a major cause of pain in the lower back, legs, neck and arms.
Although it is often managed effectively with conservative methods, there are cases in which surgery is the most appropriate option.
Accurate diagnosis and an individualised approach for each patient are the cornerstone of effective treatment.
What is a herniated intervertebral disc?
The intervertebral discs are elastic structures located between the vertebrae, acting as shock absorbers.
They are composed of a tough outer ring (annulus fibrosus) and a soft inner core (nucleus pulposus).
When the outer ring tears or weakens, the inner core may protrude and compress nearby nerve roots or the spinal cord. This condition is known as a herniated intervertebral disc.
It can occur at any level of the spine, but is particularly common in the lumbar region, which is subject to the greatest mechanical load.
Symptoms
How can I tell if I have a slipped disc in my lower back?
Symptoms vary depending on the location and size of the disc herniation. The most common include:
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Localised pain in the lower back or neck, which worsens with movement or prolonged sitting
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Radiating pain that travels down the leg (sciatica) or into the arm, depending on the level of the lesion
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Numbness or a burning sensation in the limbs
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Muscle weakness in the leg or arm
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In rare but urgent cases, disturbances in bladder function
The onset of weakness in the limbs or sphincter disturbances is a sign that requires immediate medical assessment.
The most common levels: L3–L4, L4–L5 and L5–S1
The vast majority of lumbar disc herniations occur at three specific levels.
Herniated disc L4–L5
This is the most common level. Compression of the L5 nerve root typically causes pain in the buttock, the outer part of the calf, the ankle and the dorsum of the foot, as well as the big toe. There may sometimes be weakness in dorsiflexion of the foot.
Herniated disc L5–S1
Compression of the S1 root usually presents as pain in the buttock, the back of the thigh, the posterior calf and the outer part of the foot and heel. It may occasionally be accompanied by weakness in plantar flexion of the foot.
Herniated disc L3–L4
Less common, but clinically important. Compression of the L4 root can cause pain in the front of the thigh and around the knee, together with weakness in knee extension and loss of the quadriceps tendon reflex.
Accurate identification of the affected level is crucial for planning appropriate treatment.
Diagnostic Approach
The diagnosis of a herniated intervertebral disc is based on a combination of thorough clinical examination and imaging findings.
Magnetic Resonance Imaging (MRI) is the investigation of choice, as it provides detailed visualisation of both the disc and the neural structures.
Computed Tomography (CT) is used as a complementary modality, particularly for the assessment of bony anatomy. In certain cases, electromyography (EMG) helps to map nerve damage in greater detail.
Important note: Imaging findings must always be interpreted in conjunction with the patient’s clinical picture. Incidental abnormalities on MRI without corresponding symptoms do not, in themselves, constitute an indication for treatment.
Treatment
Treatment of a herniated intervertebral disc is not uniform. It is tailored to the symptoms, their duration, the imaging findings and the individual needs of each patient.
Conservative management
In most cases, treatment starts with conservative measures. Targeted physiotherapy for a herniated disc focuses on strengthening the paraspinal muscles, improving posture and reducing the load on the disc.
Alongside this, medication with analgesics, anti‑inflammatory drugs and muscle relaxants helps to control neurogenic pain and manage symptoms. It is important to emphasise that the appropriate use of analgesic medication is a key component of effective pain control.
Selective injections
In situations where conservative treatment does not provide satisfactory relief, a selective injection of corticosteroid and local anaesthetic around the affected nerve root can have a significant anti‑inflammatory effect. Depending on the severity and duration of symptoms, selective nerve root injections may offer substantial improvement in pain and function.
When is surgery for a herniated disc needed?
Surgical intervention is considered when structured conservative treatment has been tried without adequate improvement, or when there is persistent or progressive muscle weakness, severe pain, or limitations in daily activities. The aim of surgery is to decompress the compressed nerve structures and relieve the mechanical pressure caused by the herniated disc.
Surgery is not always necessary and is only recommended when the potential benefits clearly outweigh the risks for that individual patient. The indications, expected outcomes and alternatives are discussed in detail with each patient.
Surgical techniques: Microdiscectomy and Endoscopic Discectomy
Modern minimally invasive techniques, such as microdiscectomy and endoscopic discectomy, allow safe removal of the herniated disc portion through small incisions, with minimal tissue disruption and a high success rate in symptom relief.
Microdiscectomy uses an operating microscope to provide excellent visualisation of the nerve root and the disc, enabling precise removal of the herniated fragment.
Endoscopic discectomy is performed through even smaller access ports using an endoscope, further reducing surgical trauma and shortening recovery time.
My approach as a surgeon
My clinical training in spinal surgery was completed through specialised fellowships at leading centres in the United Kingdom and Ireland, including Leeds General Infirmary, Queen’s Medical Centre in Nottingham and Beaumont Hospital in Dublin.
This experience has given me broad exposure to complex spinal disorders, including cases requiring revision surgery or multilevel procedures.
My philosophy is based on three principles: evidence‑based medicine, personalised decision‑making and clear communication with the patient.
Surgery is not always the answer.
Each case is assessed in its entirety, and the therapeutic strategy is chosen with a view to long‑term benefit and the patient’s quality of life.
Appointments
Athens & Thessaloniki
If you are experiencing symptoms of a herniated disc or already have imaging findings that need assessment, you can get in touch to arrange an appointment.
The aim of the first consultation is a thorough evaluation of the condition, a detailed explanation of the available treatment options and planning of the most appropriate therapeutic approach for each individual patient.