It is important for the clinician to conduct a thorough history and clinical examination prior to formulating a diagnosis so as not to misdiagnosis this condition. Some patients will complain of isolated “hip pain” or “knee pain,” and be evaluated and treated for this rather than a back problem. It can be complicated when the symptoms or physical findings are atypical. The diagnosis of a herniated nucleus pulposus is fairly straight-forward in most patients. Occasionally, specific tests are ordered to rule out infection or other causes or back pain and/or sciatica. There are no laboratory tests used to diagnose a herniated disc. However, some patients are not able to have an MRI, such as those patients with a cardiac pacemaker, and must have one of the other described imaging tests. MRI is now much easier to perform and generally provides better visualization of the disc injury. Before MRI was invented, patients were required to have a CT, myelogram, or CT-myelogram in order to confirm the diagnosis of herniated nucleus pulposus. A magnetic resonance imaging test (MRI) is necessary to clearly define the disc injury, and is noninvasive (no needles or dye injection). Plain x-rays of the spine will not show a herniated disc because an x-ray only shows bone structures, not the cartilage disc or spinal nerves.

Deep tendon reflexes may be diminished or absent for the particular spinal nerve that is affected.

If the spinal nerve compression is severe, it may cause significant numbness (loss of sensation) in the leg or foot and some of the leg muscles to be weak. Patients are generally in greater pain with sitting and leaning forward. The physical findings for patients with a herniated disc often include lumbar tenderness and spasm, in addition to decreased lumbar range-of motion. This condition is called cauda equine syndrome when it occurs in the lumbar spine region, and is considered to be a surgical emergency. In rare instances, a very large herniated disc can cause paraplegia and/or bowel/bladder incontinence. Patients may have difficulty sitting or finding a comfortable position because of the pain. The sciatica pain may also have a component of numbness, tingling (parasthesia), and/or weakness.

The leg symptoms may manifest as a shooting electricity pain down the buttock, back of the thigh and calf, and into the foot. The sciatica (leg pain) is typically present in one leg only, but occasionally in both. Patients may present with isolated back pain or leg pain, but it is usually both. People who perform heavy labor (and utilize proper lifting techniques) or participate in sports have nearly the same rate of injury as people who do not. However, most people presenting with a disc injury do not recall a specific event that provoked their pain, and the actual cause is indeterminate. The cause of a herniated disc injury can often be identified if someone develops severe back pain and sciatica immediately after an accident or lifting a heavy object. It occurs most frequently in people age 20-50 years old, and affects men and women equally. Although there is an extensive of list of risk factors for the development of back pain (and disc problems), a disc injury can occur in almost any person.

Compressed disk xray lumbar