Herniated Disk

Houston Methodist Hospital is ranked Best in Texas for Orthopedics and No. 15 in the nation for Neurology & Neurosurgery by U.S. News & World Report, which has also recognized Houston Methodist Hospital as a nationally ranked Honor Roll hospital. Our spine program performs more than 3,500 procedures each year, supported by a team of 55+ highly experienced spine surgeons across 33 spine centers and physical therapy locations throughout greater Houston, with a 97% positive patient satisfaction score.

When it comes to something as complex as a spinal condition, the quality of care you receive matters greatly. At Houston Methodist, patients have access to a team of fellowship-trained spine specialists and neurosurgeons who bring a depth of expertise and clinical precision to even the most challenging cases. They also have access to innovative clinical trials focused specifically on spinal cord injury recovery and postoperative pain control, offering promising new treatments not yet available to the general public. Our physicians will use advanced diagnostic imaging tests and state-of-the-art surgical technology to deliver the most advanced treatment options for your herniated disk, all tailored to your exact needs. 

Whether you are seeking a diagnosis for the first time or looking for a second opinion, Houston Methodist's spine specialists are here to help. Our compassionate team will work with you to understand the source of your pain and design a personalized treatment plan that works for you.

Common Causes of a Herniated Disk

Herniated disks can result from a combination of age-related disk degeneration, physical stress and certain lifestyle factors. The following are among the most common causes of a herniated disk:

• Age-related disk degeneration: As disks age and experience wear and tear, they lose flexibility and moisture, increasing the risk of a ruptured disk.
• Improper lifting or sudden movement: Lifting heavy objects incorrectly or twisting awkwardly can place sudden strain on the spine, which can cause a disk to herniate.
• Acute spinal injury or trauma: A fall, car accident or other sudden impact can damage the structure of a disk, causing it to rupture or shift out of place.
• Repetitive physical stress: Ongoing lifting, pulling or pushing, particularly in physically demanding occupations, gradually weakens the disks over time.
• Genetic predisposition: Some people inherit a tendency toward disk degeneration and structural weakness, making them more susceptible to herniation.
• Smoking: Smoking reduces blood supply to the spinal disks, which accelerates their deterioration and increases the likelihood of herniation.
• Obesity and excess body weight: Carrying excess weight places added load on the spinal disks, increasing the risk of damage and herniation.
• Sedentary lifestyle and poor posture: A lack of physical activity combined with a poor posture can weaken the muscles that support the spine, contributing to spinal instability over time.

Signs & Symptoms of a Herniated Disk

Symptoms of a herniated disk vary widely depending on the location and severity of the herniation and whether — and to what degree — nearby nerve roots or the spinal cord are involved. A herniated disk typically affects one side of the body, with pain stemming from either direct nerve compression or localized inflammation around the nerve root. Without appropriate treatment, a herniated disk can worsen and contribute to related spinal conditions in the affected area, including radiculopathy, spinal stenosis or myelopathy. Signs, symptoms and risk factors for other conditions differ based on whether the herniation occurs in the lumbar (lower back) or cervical (neck) region:

Herniated Lumbar Disk: Lower Back Symptoms

Symptoms of a herniated disk in the lower back can range from localized lower back pain to radiating discomfort that travels the length of the leg. Symptoms of a herniated disk in the lumbar spine may include any of the following:

• Back Pain or Tenderness: Back pain associated with a lumbar herniated disk most often occurs in the lower back, though not always. This low back pain frequently travels down into the hips, legs and feet and may worsen with prolonged sitting, bending or physical activity.
• Leg Pain and Sciatica: Depending on the location of the affected disk, leg pain may radiate from the buttocks all the way down to the foot, following the path of the sciatic nerve, commonly referred to as sciatica.
• Numbness or Tingling: May stem from the compression of the affected nerve in the lower back, and can travel down the leg. These sensations can range from intermittent to constant, depending on the degree of nerve involvement.
• Shooting or Sharp Pain: Sharp or shooting pain in one leg may worsen with sudden movements such as sneezing or coughing, and can range in intensity from mild and manageable to severe and debilitating.
• Muscle Weakness: Weakness in the muscles served by the affected nerve may cause difficulty walking or a tendency to stumble, which can affect a patient's ability to perform routine everyday activities.

Herniated Cervical Disk: Neck Symptoms

Symptoms of a herniated disk in the neck, also known as a herniated cervical disk, most commonly affect not just the neck, but also the shoulders, arms and hands. This condition can vary significantly in severity depending on how much pressure the herniation is placing on nearby spinal nerves. Symptoms of a herniated cervical disk may include any of the following:

• Neck Pain or Tenderness: Pain may occur in the back or sides of the neck, or near or between the shoulder blades. Neck pain associated with a cervical herniated disk often travels down into the arms, hands and fingers and may increase when bending or turning the neck.
• Arm Pain: Depending on the location of the affected disk, pain may radiate through the shoulder and down one arm, ranging from a persistent dull ache to a sharp, burning sensation that worsens with activity or movement.
• Numbness or Tingling: May stem from the compression of the affected nerve against the neck, and can travel down the arm and into the hands and fingers. These sensations may be intermittent or persistent, depending on the severity of the nerve compression.
• Shooting or Sharp Pain: Sharp or shooting pain in one arm may worsen with sudden movements such as sneezing or coughing, and it can significantly limit a patient's ability to move comfortably.
• Muscle Weakness: Weakness in the muscles served by the affected nerve may make it difficult to lift or hold items, and, in more advanced cases, can meaningfully impact daily functioning and independence. If muscle weakness is progressive or accompanied by loss of bowel or bladder control, seek medical evaluation immediately.

Herniated Thoracic Disk: Mid-Back Symptoms

Symptoms of a herniated disk in the mid-back, also known as a herniated thoracic disk, are less common than lumbar or cervical herniations but can be particularly significant when they do occur. The thoracic spine is relatively stable due to its attachment to the rib cage, but when a herniation does develop, it can place pressure on the spinal cord or nearby nerve roots, producing a range of symptoms that may affect the torso, abdomen and lower extremities. Symptoms of a herniated thoracic disk may include any of the following:

• Mid-Back Pain or Tenderness: Pain associated with a thoracic herniated disk most often occurs in the middle or upper back and may radiate around the torso toward the chest or abdomen. This pain can worsen with prolonged sitting, twisting or physical activity.
• Radiating Chest or Abdominal Pain: Pain may wrap around the rib cage and present as chest or abdominal discomfort, which can be mistaken for symptoms of organ-related conditions. This radiating pain follows the path of the thoracic nerve roots as they travel around the torso.
• Numbness or Tingling: Numbness and tingling may occur in the mid-back, chest, abdomen or legs, depending on the level of the affected disk and the degree of nerve involvement. These sensations may be intermittent or persistent.
• Shooting or Sharp Pain: Sharp or shooting pain may radiate from the mid-back around the torso and can worsen with sudden movements, deep breathing, sneezing or coughing.
• Muscle Weakness: In more severe cases, compression of the spinal cord by a thoracic herniated disk may cause weakness or heaviness in the legs and difficulty walking. If muscle weakness is progressive or accompanied by loss of bowel or bladder control, seek immediate medical evaluation, as this may indicate significant spinal cord compression.

How a Herniated Disk Is Diagnosed

Diagnosing a herniated disk begins with a thorough physical examination. Your doctor will ask you about your medical history and examine your back to understand your symptoms. In some cases, nerve tests or imaging may be ordered, including:

• X-rays: To evaluate spinal alignment and identify associated degenerative changes such as disk space narrowing or bone spurs, though X-rays cannot directly visualize disk herniation or soft tissue structures.
• MRI: The preferred and most comprehensive imaging tool for diagnosing a herniated disk, which provides detailed visualization of the disk, nerve roots, spinal cord and surrounding soft tissues to accurately assess the location, size and impact of the herniation.
• CT scan: To provide detailed cross-sectional imaging of the spine's bony structures, often used in combination with a myelogram or when MRI is not available or appropriate for the patient.
• Electromyography (EMG) and nerve conduction studies: To evaluate the electrical activity of muscles and the function of the nerves and confirm whether a specific nerve root is being compressed, which helps to assess the extent of any nerve damage.

Treatment Options for a Herniated Disk

Houston Methodist will assemble a team of specialists to develop a personalized treatment plan for your herniated disk. Most cases are relatively mild and can be treated at home. However, severe cases may require more intensive treatment. Here are the treatment options your team of health care providers may deploy:

Non-Surgical Treatment

Most of the time, your physician will use a non-invasive, conservative treatment for your herniated disk, focused on reducing pain and inflammation, restoring function and preventing symptom recurrence. Non-surgical treatment options may include:

• Rest and home care, including heat and cold therapy to manage pain and reduce inflammation
• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and oral steroids to reduce inflammation and offer pain relief
• Prescription medications, such as muscle relaxers, cortisone injections or narcotic pain medication for more persistent symptoms
• Physical therapy, including aquatic therapy, traction, electrical stimulation or bracing
• Injection-based treatments to address nerve pain, reduce inflammation and support diagnosis, including epidural steroid injections, nerve blocks, discography, facet and medial branch blocks and facet rhizotomy
• Integrative therapies, such as acupuncture and massage therapy
• Activity modification to avoid movements and positions that aggravate symptoms
• Healthy weight management, regular exercise and lifestyle changes to reduce mechanical load on the spine

Surgical Treatment

Surgery for a herniated disk is rare, but it may be recommended if standard treatments aren't enough to relieve symptoms. Houston Methodist surgeons use the latest robotic assistance to precisely navigate the spine's complex architecture, and our team is one of the only in Houston with expertise in endoscopic spine surgery, a minimally invasive technique that uses an incision only a few millimeters long. Surgical approaches vary depending on the patient's condition and needs. Many procedures involve removing or repositioning protruding disk material through small incisions using special equipment, avoiding many of the potential complications of open surgery. In extreme cases, the entire disk may be removed and replaced with an artificial disk. 

Specific surgical options for a herniated disk may include:

• Discectomy: Surgical removal of the damaged portion of a herniated disk, typically recommended when conservative treatments have failed
• Microdiscectomy: Minimally invasive removal of the herniated disk material compressing a nerve root, which is the most common surgical procedure for lumbar disk herniation
• Anterior cervical discectomy and fusion (ACDF): Removal of a herniated cervical disk and fusion of the adjacent vertebrae to stabilize that part of the spine
• Posterior cervical fusion (PCF): Fusion of bones in the back of the cervical spine to relieve pressure and provide stability
• Artificial disk replacement: Removal of the herniated disk and preservation of spinal motion with a prosthetic implant
• Laminectomy or laminotomy: Removal of part or all of the lamina to relieve pressure on the spinal cord or nerve roots when associated spinal stenosis is present
• Cervical laminoplasty: Restructuring of the lamina on both sides of the affected cervical vertebrae to relieve pressure on nerves in the cervical spine
• Cervical microscopic foraminotomy: Minimally invasive enlargement of the space through which a nerve root exits the spinal cord in the cervical spine
• Spinal cord stimulation (SCS): Implantation of a pulse generator that emits electrical signals to interfere with pain-causing nerve impulses
• Other minimally invasive surgery options: Surgical techniques offering reduced recovery time, blood loss and tissue disruption compared to traditional open procedures

Houston Methodist’s spine surgeons are highly experienced in performing these delicate procedures. Our less invasive approaches reduce surgery risk, speed recovery and help you return to your daily activities. Explore our spine treatment options for more information.

Across Houston, our patients have access to our expert neck, back and spine specialists so that you can get the best possible care personalized for your needs — without traveling far from home. Explore our footprint of locations in the Greater Houston area and suburbs below.