History of the Herniated Disc
The history is the patient’s story: how the symptoms began, where the symptoms are located, what is the interference in the quality of life, what relieves and what aggravates. A back disc herniation commonly causes leg pain because the herniation compresses a nerve in the spinal canal and that nerve ultimately carries information to the leg. However, the nerve compression may only cause numbness, or weakness instead of pain or may cause all or some of those symptoms in a leg. (numbness, weakness, pain). Occasionally, a central disc herniation causes symptoms in both legs through direct pressure on the nerves in the dural sac (fluid filled bag containing the nerves).

Physical Exam of the Disc Herniation
The physical exam is performed by the doctor to determine the effects of herniation. An examination of the function of the nerves in the legs determines if there is any weakness, numbness, or reflex change. An examination of the movement of the back may cause pain to radiate from the back into the effected leg. Raising the leg with the patient lying on his/her back may produce pain in the leg from compression of the nerve.

Diagnostic Studies of the Disc Herniation
The purpose of diagnostic studies is to answer the question, “where on the electrical diagram is the interruption that explains the patient’s clinical situation.” (history and physical exam) Diagnostic studies are designed to produce a picture of the interruption (MRI, Myelogram, C.A.T. scan, Discogram, etc.) or to indicate which nerve may be electrically interfered with (EMG or SSEP). The diagnostic studies must correlate with (explain) the patient’s history and physical exam to be meaningful. Many tests show age related changes that exist in people who do not have pain. (there are people who have herniated discs who do not have any symptoms and degenerative changes are common in the spine as patients mature). Therefore, the diagnostic studies must be carefully reviewed to determine if any findings on the tests are relevant to the partiular patient.Treatment of the Disc Herniation

Natural History
The natural history is the rate that nature cures a particular condition. Nature has been curing things for 3 billion years and a certain percentage of patients with a particular diagnosis are going to be healed by nature. For disc herniations, nature does a good job of relieving symptoms.
Approximately 80% of patients with a pinched back nerve will improve without surgery. Why do people with herniations pressing on a spinal nerve improve? The problem is a 3-dimensional equation between the degree of tension on the nerve and space available for the nerve. The people who improve have a favorable combination of the space available for the nerve and the degree of tension on the nerve. Nature adequately adapts the nerve to its environment in 80% of patients.

Conservative Care
The purpose of conservative care is to relieve symptoms and improve function. Conservative Treatment does not always “cure” but often it “relieves.” The laundry list of potential treatments for the herniated disc includes: physical therapy, injections, medications, etc.

Surgery
The goal of surgery is to take the pressure off the nerve by removing the herniated disc and providing adequate room for the nerve which nature failed to do. The herniation causes the symptoms in the leg, and freeing the nerve allows the potential for the nerve to reverse its “injury state” from compression. Surgery improves specific symptoms in the leg more than other symptoms. (e.g. surgery is very effective for leg pain but less effective for numbness.)