Slipped Disc: Symptoms, Diagnosis and Treatment

What Is a Slipped Disc?

The spine is made up of a series of bones called vertebrae. Between most of these vertebrae are intervertebral discs, which help distribute loads through the spine and allow movement.

Each disc has a tougher outer layer surrounding a softer central portion. Changes or damage within the disc can allow some of its material to protrude through the outer part of the disc.

This is commonly described as a:

• slipped disc
• prolapsed disc
• herniated disc
• disc herniation

The term "slipped disc" is widely used, although the disc does not literally slip out of place.

Where Do Slipped Discs Occur?

A disc prolapse can occur at different levels of the spine. This article concentrates on discs within the lumbar spine, or lower back.

Lumbar disc prolapse is particularly important because the spinal nerves travelling through the lower spine ultimately supply different areas of the legs.

If protruding disc material irritates or compresses one of these nerve roots, symptoms can extend from the back or buttock into the leg. This is commonly described as sciatica.

Disc prolapse can also occur within the cervical spine in the neck, where nerve compression may cause symptoms extending into an arm or hand.

What Causes a Slipped Disc?

Intervertebral discs change naturally over time. As a disc ages, its structure and mechanical properties can alter, making it more susceptible to degeneration and, in some people, prolapse.

A disc prolapse can sometimes develop in association with lifting, bending, twisting or another physical activity. In other cases there may be no obvious event that explains why the symptoms started.

This means it is not always possible to identify one specific movement or activity that caused a slipped disc.

What Are the Symptoms of a Slipped Disc?

The symptoms depend upon the location of the disc prolapse and whether it affects a spinal nerve.

A lumbar slipped disc may cause:

• lower back pain
• pain extending into the buttock
• pain travelling down the leg
• tingling or pins and needles
• numbness or altered sensation
• weakness affecting part of the leg or foot
• difficulty with certain movements because of pain

Some people predominantly experience back pain. Others have relatively little back pain but significant pain extending down the leg.

When a spinal nerve is affected, the pattern of pain and neurological symptoms can provide useful information about which nerve root may be involved.

Can You Have a Slipped Disc Without Symptoms?

Yes.

Not every disc prolapse causes pain or neurological symptoms. Disc abnormalities can be visible on MRI scans in people who do not have corresponding symptoms.

This is why the presence of a disc abnormality on a scan does not automatically establish that it is the cause of an individual's back or leg pain.

A specialist considers whether the location of the disc prolapse and any nerve compression correspond with the patient's symptoms and clinical examination.

What Is the Difference Between a Slipped Disc and Sciatica?

A slipped disc and sciatica are related but are not the same thing.

A slipped disc describes a structural change affecting an intervertebral disc. Sciatica describes a pattern of symptoms caused by irritation or compression of a nerve supplying the leg.

A lumbar disc prolapse is one of the common causes of sciatica.

When disc material presses on a spinal nerve root, a person may experience pain travelling from the lower back or buttock into the leg, sometimes accompanied by tingling, numbness or weakness.

However, sciatica can have other causes, including narrowing around the spinal nerves caused by lumbar spinal stenosis.

Read more about Leg Pain / Sciatica.

Where Is Slipped Disc Pain Felt?

The location of symptoms depends partly upon which spinal structures and nerves are affected.

A lumbar disc prolapse can cause localised lower back pain, but nerve irritation can produce symptoms elsewhere.

Depending upon the nerve involved, pain may extend into areas such as:

• the buttock
• the back or side of the thigh
• the front or side of the lower leg
• the calf
• the ankle
• the foot or toes

The distribution of pain, numbness and weakness can help a clinician determine which nerve may be affected, although symptoms do not always follow an identical pattern in every patient.

Can a Slipped Disc Cause Numbness or Weakness?

Yes. If a prolapsed disc compresses a spinal nerve, it can affect both sensation and muscle function.

Possible symptoms include:

• numbness in part of the leg or foot
• pins and needles or altered sensation
• weakness in particular movements
• difficulty lifting part of the foot in more significant cases

Progressive or significant weakness warrants medical assessment. Sudden severe neurological symptoms, particularly when associated with bladder, bowel or saddle-area sensory changes, require urgent assessment.

How Is a Slipped Disc Diagnosed?

Diagnosis begins with the clinical history and examination rather than a scan alone.

A clinician may ask about:

• how and when the symptoms started
• the location of back and leg pain
• whether pain travels below the knee
• numbness, tingling or altered sensation
• weakness in the leg or foot
• activities or positions that affect the symptoms
• previous episodes of back or leg pain
• previous treatment

A physical examination may include assessment of movement, muscle strength, sensation and reflexes. Tests that place controlled tension on the nerves may also help determine whether symptoms are consistent with nerve root irritation.

The findings can then be used to decide whether further investigation is necessary.

Do I Need an MRI for a Slipped Disc?

Not everyone with symptoms consistent with a slipped disc requires an immediate MRI scan.

Many episodes improve with time and non-surgical management. When symptoms are improving and there are no concerning neurological features, imaging may not change the initial treatment.

An MRI may be considered when:

• significant symptoms persist
• there is numbness or weakness requiring further assessment
• the diagnosis is uncertain
• another spinal condition is suspected
• an injection or surgical treatment is being considered

MRI can show the intervertebral discs, spinal nerves and surrounding structures in detail and can help establish whether a disc prolapse corresponds with the clinical symptoms.

Read more: MRI Scans for Lower Back Pain: When Are They Needed?

Can a Slipped Disc Heal Without Surgery?

Many people with a symptomatic lumbar disc prolapse improve without surgery.

The natural history varies between individuals, but pain and nerve irritation can settle over time. This is why non-surgical treatment is often appropriate initially when there are no indications for urgent surgical intervention.

Improvement in symptoms is more important than whether a disc continues to look abnormal on imaging. A person does not necessarily need a completely "normal" MRI scan in order to recover clinically.

How Is a Slipped Disc Treated?

Treatment depends upon the severity and duration of symptoms, the degree of functional limitation, neurological findings and the individual patient's circumstances.

For many people, initial treatment is non-surgical.

Activity and Movement

Prolonged bed rest is generally not recommended for uncomplicated back pain or sciatica. Remaining appropriately active and gradually returning to normal activities can form an important part of recovery.

The appropriate level of activity depends upon the severity of symptoms and individual circumstances.

Pain Management

Medication may sometimes be used to help manage symptoms, although the appropriate medication depends upon the individual and should take account of potential risks, other medical conditions and medicines already being taken.

Advice about medication should be obtained from an appropriate healthcare professional.

Physiotherapy and Rehabilitation

Physiotherapy or rehabilitation may be appropriate for some patients. This can include advice about movement, exercise and gradually returning to normal function.

The programme should be appropriate to the individual's symptoms and stage of recovery.

Spinal Injections

Selected patients with severe sciatica may be considered for an epidural injection containing local anaesthetic and steroid.

An injection does not physically remove the disc prolapse. Its role is generally to help reduce symptoms associated with nerve irritation in appropriately selected patients.

When Might Surgery Be Considered for a Slipped Disc?

Most people with a slipped disc do not require surgery.

Surgery may be considered when significant sciatica or neurological symptoms persist despite appropriate non-surgical management and imaging demonstrates nerve compression that corresponds with the patient's symptoms.

Other factors considered can include:

• the severity of leg pain
• how long symptoms have been present
• the effect on mobility, sleep, work and everyday activities
• numbness or weakness
• response to previous treatment
• the MRI findings
• the expected benefits and risks of surgery

Progressive neurological weakness can require earlier specialist consideration.

The decision is therefore based on the patient, symptoms, clinical findings and imaging together rather than the appearance of the disc on MRI alone.

What Operation Is Used for a Lumbar Slipped Disc?

When surgery is appropriate for sciatica caused by a lumbar disc prolapse, the aim is generally to relieve pressure on the affected spinal nerve.

This may involve a procedure called a discectomy, in which the portion of prolapsed disc material responsible for compressing the nerve is removed.

Different surgical approaches and techniques can be used depending upon the location of the disc prolapse, the patient's anatomy and the surgeon's assessment.

Not every disc prolapse is suitable for, or requires, an operation. The potential benefits and risks should be discussed individually before a decision about surgery is made.

Does Surgery Remove the Whole Disc?

In a typical discectomy for a lumbar disc prolapse, the aim is not necessarily to remove the entire intervertebral disc.

The operation is intended to decompress the affected nerve by removing the disc material responsible for the compression, with the precise surgical approach determined by the individual circumstances.

Can a Slipped Disc Come Back?

Symptoms from a disc prolapse can recur.

Some people experience further episodes of back or leg pain after their original symptoms have settled. Recurrent symptoms do not necessarily mean that another disc prolapse has occurred, as back and leg pain can have several possible causes.

If significant sciatica returns, particularly following previous disc surgery, reassessment may be appropriate to establish the cause.

Is a Slipped Disc the Same as Spinal Stenosis?

No.

Both conditions can compress spinal nerves and cause leg symptoms, but the underlying problems are different.

A slipped disc involves protrusion or herniation of disc material. Lumbar spinal stenosis refers to narrowing within the spinal canal or around the spaces through which the spinal nerves travel.

A disc prolapse often causes more typical sciatic pain extending into a leg. Lumbar spinal stenosis can produce pain, heaviness, numbness or weakness in the legs that is particularly noticeable during standing or walking.

The two conditions can also coexist.

Read more: Lumbar Spinal Stenosis: Symptoms and Treatment.

When Does a Slipped Disc Require Urgent Medical Attention?

Most slipped discs do not constitute a medical emergency. However, significant compression of the nerves at the bottom of the spinal canal can rarely result in cauda equina syndrome.

Seek urgent or emergency medical assessment if back or leg pain is associated with new difficulty controlling or passing urine or stools, loss of sensation around the genitals or anus, or significant or worsening loss of feeling or weakness affecting the legs.

These symptoms should not be monitored at home or assessed solely using information online.

Significant or rapidly progressive muscle weakness also requires prompt medical assessment.

Frequently Asked Questions About Slipped Discs

Is a slipped disc serious?

Not necessarily. Disc prolapses are common and some cause no symptoms at all. When a disc compresses a nerve it can cause significant pain or neurological symptoms, but many people improve without surgery. Certain neurological symptoms require urgent assessment.

How do I know if my back pain is caused by a slipped disc?

Symptoms alone cannot always confirm the cause of back pain. A disc prolapse may be suspected from the pattern of back and leg symptoms and clinical examination. MRI may be used when imaging is clinically appropriate to determine whether a disc abnormality corresponds with the symptoms.

Can a slipped disc cause sciatica?

Yes. A lumbar disc prolapse is a common cause of sciatica. If the disc irritates or compresses a nerve root, pain can travel from the lower back or buttock into the leg and may be accompanied by tingling, numbness or weakness.

Does a slipped disc always need an MRI?

No. An immediate MRI is not required for every suspected disc prolapse. Imaging may be considered when symptoms persist, significant neurological symptoms are present, the diagnosis is uncertain, or the result is likely to influence further treatment.

Does a slipped disc always require surgery?

No. Most slipped discs do not require an operation. Surgery may be considered for selected patients with persistent significant sciatica or neurological symptoms where imaging demonstrates nerve compression that corresponds with the clinical findings.

Can a slipped disc get better on its own?

Yes. Many people with symptoms caused by a lumbar disc prolapse improve over time with appropriate non-surgical management. The rate and extent of recovery varies between individuals.

About This Article

This article provides general information about lumbar disc prolapse, commonly known as a slipped disc. It is not intended to diagnose an individual's symptoms or replace personalised medical advice.

Medically reviewed by Professor Nasir A. Quraishi
Consultant Spinal Surgeon & Honorary Professor

Clinical sources: NICE guidance on low back pain and sciatica in people aged 16 and over, and NHS guidance on slipped discs, back pain and sciatica.

Further Information

If you have persistent lower back pain, sciatica or neurological symptoms affecting a leg, specialist assessment can help determine whether a disc prolapse or another spinal condition may be responsible and whether further investigation or treatment is appropriate.

Learn more about Lumbar / Back Pain

Learn more about Leg Pain / Sciatica

What Causes Lower Back Pain?
MRI Scans for Lower Back Pain: When Are They Needed?
When Should I See a Spine Specialist for Back Pain?
Lumbar Spinal Stenosis: Symptoms and Treatment
When Does Back Pain Require Surgery?