Herniated Disc and Spinal Canal Stenosis

What is a herniated disc?

In a herniated disc (disc prolapse), the soft core of an intervertebral disc protrudes through the outer fibrous ring and can press on nerve roots or the spinal cord. The lumbar spine is most commonly affected, the cervical spine less often.

A spinal canal stenosis is a narrowing of the spinal canal that can likewise lead to compression of nerve structures. It frequently occurs in older age.

Symptoms

Herniated disc of the lumbar spine

  • Back pain radiating into the leg (sciatica)
  • Tingling or numbness in the leg or foot
  • Muscle weakness (e.g. foot drop)
  • Worsening when coughing, sneezing or straining

Herniated disc of the cervical spine

  • Neck pain radiating into the arm and hand
  • Tingling or numbness in the fingers
  • Muscle weakness in the arm

Spinal canal stenosis

  • Load-dependent leg pain when walking (neurogenic claudication)
  • Relief when bending forward or sitting down
  • Progressively shortening walking distance
  • Numbness and weakness in the legs
Warning

Sudden bladder or bowel dysfunction, numbness in the genital area, or rapidly progressing paralysis is an emergency (cauda equina syndrome). Go to an emergency department immediately.

Causes

  • Age-related wear of the intervertebral discs (degeneration)
  • Improper loading and excess weight
  • Lack of exercise and weak back muscles
  • Heavy lifting with incorrect technique
  • Genetic predisposition
  • In spinal canal stenosis: bony outgrowths (spondylarthrosis), thickened ligaments

Diagnostics

  • Neurological examination – reflex testing, sensation, strength testing, Lasègue sign
  • Nerve conduction velocity (NCV) and EMG – to assess nerve root damage and distinguish it from other causes (e.g. polyneuropathy)
  • Imaging – MRI of the spine (referral) to visualize the herniated disc or the stenosis

Treatment

Conservative therapy (sufficient in most cases)

  • Pain management (NSAIDs such as Ibuprofen, and short-term cortisone if needed)
  • Physiotherapy and remedial exercise
  • Back care training and posture training
  • Heat applications
  • Muscle relaxants for severe tension
  • For neuropathic pain: Pregabalin or Gabapentin

Surgical therapy

  • Only for persistent severe symptoms, progressive paralysis, or cauda equina syndrome
  • Referral to neurosurgery or spinal surgery

Prevention

  • Regular exercise and strengthening of the back muscles
  • Ergonomic workplace
  • Correct lifting and carrying
  • Weight reduction in case of excess weight

Book an appointment

Last updated: 2026-07-04