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How is a herniated lumbar disc diagnosed?

The physician will use a combination of history (patient interview), physical examination, and imaging (Xray, MRI, CT scan, etc.) to make a diagnosis of herniated disc.

The history is the information the patient gives the physician about the injury. The doctor will want to know:
  • how the pain began, how long it has been going on,and how severe it is.
  • if an accident or fall preceded the pain.
  • The the state of the patient's general health.
  • which medications the patient is taking (both prescription and over the counter).
  • other treatments that have been tried and whether any of them have been helpful.
The doctor will check several functions in the physical examination:
  • Gait: The doctor may ask the patient to walk normally, then walk on heels and finally on toes to check balance, as well as perform other maneuvers.
  • Range of motion: The patient may be asked to bend over and lean backwards and sideways to examine the mobility of the back.
  • Back examination: The back will be checked for curvatures, muscle spasm, and tenderness.
  • Examination of the legs: Other conditions such as hip problems, leg length differences, circulation problems and injuries to the legs must be checked.
  • Nerve root tension signs: The doctor may stretch the legs in various ways to see if stretching a nerve will reproduce the pain. This helps determine if a nerve is compressed. The most common of these tests is the "straight leg raise".
  • Neurologic examination: The doctor will evaluate as many nerve functions as possible in the patient's legs. This will include checking the sense of touch using a pin prick and evaluating the strength in several leg muscles. The reflexes at the knee and ankle will also be tested.
It is often necessary to obtain an X-ray, MRI, bone scan, or myelogram. Since many people recover completely in a short time, most doctors suggest waiting until the condition has failed to respond to several weeks of conservative (non-operative) treatment before getting imaging studies.
  • X-rays: The most common imaging study is the X-ray, which is best suited for looking at the bones. Fractures, disc degeneration, arthritis and spinal deformities are also visible on regular X-rays. Abnormal movements of the vertebrae can be identified if X-rays are made while the patient is bending forward or leaning backward.
  • Computed Tomography (CT scan): This is a special type of X-ray that shows soft tissues (disc, nerve, muscle and ligament) more clearly than a regular X-ray. CT scans are about 83% accurate at diagnosing a herniated disc.
  • MRI (Magnetic Resonance Imaging): The MRI is ordered only after a period of unsuccessful conservative treatment. The MRI is extremely good at showing the discs, nerves, spinal cord, spinal fluid, muscles and ligaments. It is about 93% accurate at finding herniated discs.
  • Myelogram and Post Myelogram CT Scan: During a myelogram the radiologist injects dye into the spinal fluid. A series of X-rays is followed by a CT scan. The dye outlines the nerves and makes them easier to see. This method is also about 93% accurate at identifying herniated discs, but most doctors prefer an MRI because it does not require an injection. A myelogram and post myelograin CT scan is often done when an earlier MRI was not conclusive.

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