Our Specialists for Lumbar Disc Herniation
Most lumbar disc herniations don't need an operation — but when they do, the surgeon matters. These are the UChicago spine surgeons who see this problem every week and decide, with you, whether surgery will help.
Dr. Bydon is the Chair of Neurological Surgery at UChicago and a pioneer in minimally invasive and robotic spine surgery. He led the stem cell trial, the first-in-human stem cell therapy for spinal cord injury, and holds 12 medical device patents with over 600 peer-reviewed publications. He was recruited to UChicago from Mayo Clinic. Dr. Bydon is the Chair of Neurological Surgery at UChicago and has built his career around minimally invasive and robotic-assisted lumbar surgery — including microdiscectomy for herniated discs. He has published extensively on outcomes and recurrence patterns after lumbar disc surgery, drawing on experience with thousands of spine operations performed at Mayo Clinic before he was recruited to UChicago.
Dr. Herman is Program Director of the Neurological Surgery Residency and a complex spine surgeon who practices the full spectrum of spine and neurorestoration procedures. He co-developed a fully implantable wireless intraspinal microstimulation device for restoring motor function after spinal cord injury, with publications in Artificial Organs and Scientific Reports. He has been named a Top Chicago Doctor for over a decade. Dr. Herman is one of the UChicago spine surgeons who sees patients with sciatica from lumbar disc herniations every week, and he practices the full spectrum of lumbar decompression — from standard microdiscectomy to complex revisions for recurrent herniations. As Program Director of the Neurosurgery Residency, he trains the next generation of spine surgeons in these techniques.
Dr. Witham is Section Chief of Spine Surgery at UChicago and a pioneer in augmented reality-guided spine surgery. In 2020 he performed the first FDA-cleared AR-guided spine surgery on a living patient using the xvision system, and he has published extensively on AR-assisted pedicle screw placement. He came to UChicago from Johns Hopkins, where he was Professor of Neurological Surgery and Orthopaedic Surgery and served as co-program director of the neurosurgery residency. Dr. Witham is Section Chief of Spine Surgery at UChicago and a pioneer in augmented reality-guided spine surgery, including the first FDA-cleared AR-guided spine procedure on a living patient. For lumbar disc herniation, he applies the same image-guided, minimally invasive philosophy he has published on in high-impact peer-reviewed work (J Neurosurg Spine, 2021).
What Is a Lumbar Disc Herniation?
Between each bone in your lower spine sits a rubbery cushion called an intervertebral disc. Each disc has a tough outer ring (the annulus) and a softer, jelly-like center (the nucleus pulposus). A herniation happens when part of that soft center pushes through a weak spot in the outer ring and presses on a nearby nerve root.
The disc itself isn't usually the problem — the problem is that the displaced material is crowding one of the nerves that travels from your low back down into your leg. That's why the classic symptom isn't just back pain; it's pain, tingling, or weakness that shoots down the leg — what most people call sciatica.
Herniations are common. They peak in people aged 30-50, affect men slightly more than women, and most often occur at the bottom two levels of the lumbar spine (L4-L5 and L5-S1). The good news: the vast majority of herniations get better without surgery. Studies using repeat MRI scans show that the body actually reabsorbs disc material over time — roughly 70% of extruded herniations and more than 90% of sequestered fragments shrink on their own within a year.
At a Glance
- A lumbar disc herniation is a soft spinal disc that has bulged or ruptured into the space where nerve roots travel — often causing the leg pain people call sciatica.
- Most herniations get better on their own: about two-thirds shrink or resorb over time, and most patients improve without surgery.
- First-line treatment is non-operative — activity modification, physical therapy, anti-inflammatories, and sometimes an epidural steroid injection.
- Microdiscectomy is a small, targeted operation that reliably relieves sciatica in properly selected patients, usually as a same-day procedure.
- Urgent surgery is needed only for cauda equina syndrome or a progressive neurologic deficit — these are emergencies.
Have imaging or a diagnosis already?
We'll have a specialist review your MRI and records — often within 24 hours.
What Does It Feel Like?
The symptoms come from the nerve that's being pinched — not the disc itself. Where you feel it depends on which nerve root is involved.
Classic symptoms
- Leg pain that's worse than the back pain — often sharp, electric, or burning, running from the buttock down the thigh or calf and sometimes into the foot
- Pain that gets worse with sitting, bending, coughing, or sneezing
- Numbness or tingling along a specific strip of skin in the leg or foot
- Weakness in specific muscles — for example, difficulty lifting the foot (foot drop), trouble rising on your toes, or a buckling knee
- Pain relief when lying down flat
Red flags — call us right away
A small number of herniations press on multiple nerves at once and become a true emergency called cauda equina syndrome. Get immediate medical attention if you have any of the following:
- New difficulty controlling your bladder or bowels, or numbness in the groin/inner thighs ("saddle anesthesia")
- Rapidly worsening weakness in one or both legs
- Severe, progressive numbness
These findings can mean that nerves are being crushed, and timely surgery — ideally within 24-48 hours — gives the best chance of recovery.
How Is It Diagnosed?
Most of the diagnosis happens in the exam room, not the scanner. A careful history and neurologic exam — testing strength, sensation, reflexes, and maneuvers like the straight leg raise — can usually pinpoint which nerve root is irritated before any imaging is ordered.
MRI is the most useful imaging test. It shows the disc, the nerve roots, and how they interact in exquisite detail. We typically order an MRI if symptoms aren't improving after 4-6 weeks of conservative care, if there are progressive neurologic findings, or any time there are red flags.
One important caveat: MRI findings alone don't decide treatment. A large number of people without any leg pain have disc bulges or herniations on imaging. Your MRI needs to match your symptoms and your exam. If it doesn't, operating on the disc is unlikely to make you feel better.
X-rays, CT scans, and electrodiagnostic studies (EMG/nerve conduction) can occasionally add information, but MRI remains the gold standard for surgical planning.
How Is It Treated?
Start with non-operative care — it works for most people
Because most herniations improve on their own, the first line of treatment is almost always non-surgical. A typical plan includes:
- Activity modification — stay active within your limits, but avoid the movements that clearly provoke symptoms
- NSAIDs and short courses of oral steroids to calm the inflammation around the nerve root
- Physical therapy focused on core stabilization, nerve glides, and gradual reconditioning
- Epidural steroid injections for patients whose leg pain is severe or not responding — these offer moderate short-term relief and can help patients get through physical therapy without surgery
Most patients who follow this plan improve substantially within 6-12 weeks. The goal isn't to avoid surgery at all costs — it's to give your body a real chance to heal itself before taking on the risks of an operation.
When surgery is the right answer
Surgery is considered when leg pain is severe and persistent despite 6-12 weeks of conservative care, when there's a meaningful neurologic deficit, or urgently when there's cauda equina syndrome or rapidly progressing weakness. The procedure of choice for a typical single-level herniation is a microdiscectomy.
Microdiscectomy
A microdiscectomy is a small, targeted operation done through an incision about an inch long. Using an operating microscope, the surgeon removes just the fragment of disc that's pressing on the nerve root — the rest of the disc is left in place. It's typically a same-day procedure; most patients walk the same afternoon and go home within a few hours.
Results are consistent and predictable. The SPORT trial, the largest randomized study ever done on this question, showed that patients who chose surgery had faster and larger improvements in leg pain, function, and disability than patients who stuck with non-operative care — and those benefits held up at 4 and 8 years of follow-up.
Tubular and endoscopic discectomy
Smaller, more minimally invasive approaches use a tubular retractor or an endoscope to reach the disc through an even smaller corridor. Randomized trials comparing tubular discectomy to standard microdiscectomy show essentially equivalent long-term clinical outcomes at 5 years — patients get the same relief with a slightly different corridor. Endoscopic discectomy is a similar story: excellent results in the right hands, with a slightly steeper learning curve. The best approach for you depends on the anatomy of your herniation and your surgeon's experience.
Urgent surgery for cauda equina syndrome
Cauda equina syndrome is a surgical emergency. The standard of care is decompression as soon as safely possible — ideally within 24-48 hours of symptom onset — to maximize the chance of recovering bladder, bowel, and motor function. This is one of the few situations in spine surgery where time genuinely matters.
Considering surgery or planning a second opinion?
Our multidisciplinary team reviews complex cases together. You'll get a coordinated plan, not one opinion.
What Are the Outcomes?
Lumbar disc herniation has some of the best outcomes in spine surgery. In the right patient, microdiscectomy produces durable leg pain relief, strong functional recovery, and a reliable return to work. Here is what the best evidence shows:
| Outcome | What to expect | Source |
|---|---|---|
| Leg pain relief at 1 year | Large, sustained improvement; surgery outperforms non-operative care | SPORT trial |
| Function at 5 years | Improvements largely maintained; minimal drop-off from year 1 | SPORT 4- and 8-year results |
| Same-level recurrence | Approximately 5-15% over long-term follow-up | Multiple cohort studies |
| Return to work | Median around 3-4 weeks for sedentary jobs; longer for heavy labor; roughly 75-85% returning overall | Systematic review, Spine 2025 |
| Spontaneous regression (no surgery) | ~70% of extruded and ~90%+ of sequestered fragments shrink on MRI | Chiu et al. meta-analysis |
A few things are worth emphasizing. First, choosing surgery isn't a failure — for properly selected patients with severe leg pain, the evidence is clear that surgery gets you better, faster. Second, non-operative care is also highly effective — at long-term follow-up, most patients who started conservatively end up doing well. Third, the small but real recurrence rate is why we counsel patients carefully about body mechanics, weight management, and smoking cessation after surgery.
Where surgical experience matters most is in deciding when not to operate, in matching the right technique to the right anatomy, and in handling the unusual cases — large far-lateral herniations, upward-migrated fragments, cauda equina, or patients with multiple prior surgeries. That's the day-to-day work of an experienced spine team.
References
Have Questions About a Lumbar Disc Herniation?
Our team is here to review your case, discuss your options, and help you take the next step.
Schedule: (773) 702-2123