Overview
A spinal disc acts as a cushion between two vertebrae, with a tough outer wall surrounding a softer, gel-like center. When that outer wall weakens or develops a tear, the inner material can bulge or push through it — a condition known as a herniated (or slipped) disc. This can happen in the neck (cervical spine) or the lower back (lumbar spine), the two regions of the spine that handle the most day-to-day motion and load.
Most herniated discs develop gradually, as normal age-related wear reduces a disc's flexibility and resilience over time. A specific event — lifting, twisting, or an awkward movement — often triggers or worsens a disc that has already been weakening for years. When the herniated material presses on or irritates a nearby spinal nerve, it can produce the pain, numbness, or weakness that brings most patients to a spine specialist.
It's worth knowing up front: most herniated discs improve over time without surgery. Dr. Gerlach's approach starts with a thorough exam and imaging review to understand exactly where the herniation is and which structures it's affecting, then builds a plan around non-operative care whenever it's a reasonable path forward.
Symptoms
Symptoms vary depending on where the disc is located and which nerve, if any, is affected. Common signs include:
- Pain that radiates down an arm or a leg, often following the path of a specific nerve
- Numbness or tingling in the arm, hand, leg, or foot
- Weakness in specific muscle groups that can make gripping, lifting, or walking more difficult
- Pain that worsens with sitting, bending forward, or coughing and sneezing
- Neck or low back pain alone, without any arm or leg symptoms, is also common
- New bowel or bladder dysfunction, numbness in the saddle or groin area, or rapidly progressive leg weakness are emergency signs — go to the emergency department rather than waiting for a scheduled appointment.
Treatment Options
Treatment for a herniated disc almost always begins with non-surgical care. Depending on your symptoms, this can include activity modification, anti-inflammatory medication, physical therapy focused on the affected region, and targeted spinal injections to reduce inflammation around the irritated nerve. Many patients see meaningful improvement through this kind of program alone.
Surgery is considered when symptoms don't respond to a full trial of conservative treatment, or when there is significant or progressive weakness that suggests ongoing nerve pressure. In the lower back, the most common surgical option is a microdiscectomy — removing the portion of disc material that is pressing on the nerve. In select cervical cases, artificial disc replacement may be an appropriate option that preserves motion at the treated level.
Dr. Gerlach reviews each case individually — imaging, exam findings, and how much conservative care has already been tried — to recommend the option that fits your specific situation, always starting from non-operative management whenever appropriate.
Frequently Asked Questions
Will my herniated disc heal on its own?
Many herniated discs do improve on their own over weeks to months with non-surgical care such as activity modification, physical therapy, and, when appropriate, medication or injections.
When is surgery considered?
Surgery is generally considered when there is progressive weakness, or when pain persists despite a full trial of conservative treatment.
What surgical options exist?
Options include microdiscectomy to remove the herniated portion of the disc; in appropriate cervical cases, artificial disc replacement is another option that preserves motion.