The full content of Annals is available to subscribers

Subscribe/Learn More  >
Diagnosis and Treatment |

Herniated Lumbar Intervertebral Disk

Richard A. Deyo, MD; John D. Loeser, MD; and Stanley J. Bigos, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by the Northwest Health Services Research and Development Field Program, Seattle Veterans Affairs Medical Center, and by grant HS06344-01 from the National Center for Health Services Research and Technology Assessment.

Requests for Reprints: Richard A. Deyo, MD, Seattle Veterans Affairs Medical Center (152), 1660 South Columbian Way, Seattle, WA 98108.

Current Author Addresses: Dr. Deyo: Seattle Veterans Affairs Medical Center (152), 1660 South Columbian Way, Seattle, WA 98108.

Dr. Loeser: Department of Neurological Surgery, RI-20, University of Washington School of Medicine, Seattle, WA 98195.

Dr. Bigos: Department of Orthopaedics, RK-10, University of Washington School of Medicine, Seattle, WA 98195.

©1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(8):598-603. doi:10.7326/0003-4819-112-8-598
Text Size: A A A

Low back pain is common, but a herniated intervertebral disk is the cause in only a small percentage of cases. Most symptomatic disk herniations result in clinical manifestations (pain, reflex loss, muscle weakness) that resolve with conservative therapy, and only 5% to 10% of patients require surgery. Sciatica is usually the first clue to disk herniation, but sciatica may be mimicked by other disorders that cause radiating pain. Because more than 95% of lumbar disk herniations occur at the L4-5 or L5-S1 levels, the physical examination should focus on abnormalities of the L5 and S1 nerve roots. Plain radiography is not useful in diagnosing disk herniation, but more sophisticated imaging (myelography, computed tomography, or magnetic resonance imaging) should generally be delayed until a patient is clearly a surgical candidate. Conservative therapy includes nonsteroidal anti-inflammatory drugs, brief bed rest (often for less than 1 week), early progressive ambulation, and reassurance about a favorable prognosis. Muscle relaxants and narcotic analgesics have a limited role, and their use should be strictly time-limited. Conventional traction and corsets are probably ineffective. Except for patients with the cauda equina syndrome, surgery is generally appropriate only when there is a combination of definite disk herniation shown by imaging, a corresponding syndrome of sciatic pain, a corresponding neurologic deficit, and a failure to respond to 6 weeks of conservative therapy.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.