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Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist.

A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg called "sciatica". Sciatica affects about 1 to 2% of all people, usually between the ages of 30 and 50.

A herniated lumbar disc may also cause back pain, although back pain alone (without leg pain) can have many causes other than a herniated disc.

Most (80 to 90%) patients with a new or recent acute disc herniation will improve without surgery. The doctor will usually try using nonsurgical treatments for the first few weeks. If the pain still keeps you from your normal lifestyle after completing treatment, your doctor might recommend surgery. Although surgery may not return leg strength to normal, it can stop your leg from getting weaker, and relieve leg pain. Surgery is usually recommended for relief of leg pain (greater than 90% success); surgery is less effective in relieving back pain.

Your doctor may prescribe nonsurgical treatments including a short period of rest, anti-inflammatory medications to reduce the swelling, analgesic drugs to control the pain, physical therapy, exercise or epidural steroid injection therapy. If you are told to rest, follow your doctor’s directions on how long to stay in bed. Too much bed rest may give you stiff joints and weak muscles, which will make it harder to do activities that could help reduce the pain. Ask your doctor whether you should continue to work while you are being treated.

Medications used to control pain are called analgesics. Most pain can be treated with non-prescription medications such as aspirin, ibuprofen, naproxen, or acetaminophen. If you have severe persistent pain, your doctor might prescribe narcotics for a short time. Sometimes, but not often, a doctor will prescribe muscle relaxants. However, you want to take only the medication you need because taking more doesn’t help you recover faster, might cause unwanted side effects (such as constipation and drowsiness), and can result in dependency. All medication should be taken only as directed. Make sure you tell your doctor about any kind of medication you are taking—even over-the-counter drugs—and if he/she prescribes pain medication, let him/her know how it is working for you.

Non-steroidal anti-inflammatory medications (NSAIDs) are analgesics and are also used to reduce swelling and inflammation that occur as a result of disc herniation. These include aspirin, ibuprofen, naproxen, and a variety of prescription drugs. If your doctor gives you anti-inflammatory medications, you should watch for side effects like stomach upset or bleeding. Chronic use of prescription or over-the-counter NSAIDs should be monitored by your physician for the development of any potential problems.

There are other medications that also have an anti-inflammatory effect. Corticosteroid medications—either orally or by injection—are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Corticosteroids, like NSAIDs, can have side effects. Risks and benefits of this medication should be discussed with your physician. Epidural injections or "blocks" may be recommended if you have severe leg pain. These are injections of corticosteroid into the epidural space (the area around the spinal nerves), performed by a doctor with special training in this technique. The initial injection may be followed by one or two more injections at a later date, and should be done as part of a comprehensive rehabilitation and treatment program.

Trigger point injections are injections of local anesthetics (sometimes combined with corticosteroids) directly into painful soft tissue or muscles along the spine or over the back of the pelvis. While occasionally useful for pain control, trigger point injections do not help heal a herniated lumbar disc. 

Surgery

The goal of surgery is to make the herniated disc stop pressing on and irritating the nerves, causing symptoms of pain and weakness. The most common procedure is called a "discectomy" or "partial discectomy," in which part of the herniated disc is removed. In order to see the disc clearly, sometimes it is necessary to remove a small portion of the lamina, the bone behind the disc. Bone removal may be minimal (hemi-laminotomy) or more extensive (hemi-laminectomy). Some surgeons use an endoscope or microscope in some cases.

Discectomy can be done under either local, spinal or general anesthesia. The patient lays face down on the operating table, generally in a kneeling position. A small incision is made in the skin over the herniated disc and the muscles over the spine are pulled back from the bone. A small amount of bone may be removed so the surgeon can see the compressed nerve. The herniated disc and any loose pieces are removed until they are no longer pressing on the nerve. Any bone spurs (osteophytes) are also taken out to make sure that the nerve is free of pressure. Usually, there is very little bleeding.