Lumbar and Cervical Disc Herniation: What Are They, What Causes Them, How Are They Treated?

Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery

One of the sentences I hear most often in my clinic is this: “Doctor, it’s a herniation after all; isn’t it the same thing wherever it is?” In fact, this question reflects a very apt curiosity. Lumbar disc herniation and cervical disc herniation arise, fundamentally, from the same process: the disc between the vertebrae protruding out of place and pressing on a nerve. However, the picture they create in the body, the way they affect daily life, and their treatment plans differ from one another to a considerable degree. In this article, I want to address the two together, comparatively: what causes them, how they are distinguished, when one needs to worry, and what is really done in treatment.

Let me note something reassuring from the outset: “herniation” is not as frightening a word as it sounds. The great majority of my patients recover without having surgery.

What Is a Herniation? The Structure of the Spine and the Discs

Our spine consists of vertebrae stacked one on top of another, extending from the base of the skull to the tailbone. Between these vertebrae are the cushions called discs. The discs are shock absorbers with a fibrous, sturdy ring on the outside (the annulus fibrosus) and a soft, gel-like center inside (the nucleus pulposus); during movement, they give the spine both flexibility and the ability to absorb shock.

Over the years, these discs lose their water content and elasticity. With strain or wear, the outer ring weakens; the center inside protrudes outward. If this protruding part presses on the neighboring nerve root or the spinal cord, then the picture we call a herniation emerges. This process can occur at any level of the spine; however, it is most often seen in the lower back (lumbar) and neck (cervical) regions.

Here I would like to underline a very important point: the protrusion of the disc does not, on its own, mean disease. What creates complaints is not the protrusion itself, but the pressure it exerts on the nerve. That is why a herniation can also be seen on the MRIs of healthy people who have no complaints at all.

What Is a Lumbar Disc Herniation? What Are Its Symptoms?

A lumbar disc herniation is the herniation of the disc in the lower part of the spine, pressing on a nerve root. It is most often seen at the L4-L5 and L5-S1 levels — that is, in the lowest, most load-bearing part of the lower back. Because the lumbar region bears the greater part of the body’s weight and is exposed to more mechanical stress, lumbar disc herniation comes before us markedly more often than cervical disc herniation.

Its most typical symptom is pain radiating from the lower back to the hip and the leg. This pain, known colloquially as “sciatica,” can sometimes travel all the way down to the foot. Alongside it, the complaints that may be seen are:

Numbness, tingling, or a burning sensation in the leg or foot
Pain that increases with bending forward, sitting for long periods, and lifting heavy loads
Pain that intensifies with coughing and sneezing
Loss of strength in the leg, difficulty walking
Spasm and stiffness in the lower back muscles

My patients generally say this: “What really wears me down is not my back, but the pain shooting into my leg.” This statement is, in fact, one of the most important clues to the diagnosis.

What Is a Cervical Disc Herniation? What Are Its Symptoms?

A cervical disc herniation is the herniation of the disc between the neck vertebrae. It is most often seen at the C5-C6 and C6-C7 levels. The neck region does not bear as much weight as the lower back; however, it must constantly balance the weight of our head and is extremely mobile. Nowadays, the habit of looking at the phone and the computer with the head bent forward for long periods (“text neck”) has come to strain this region far more than before.

In a cervical disc herniation, the pain typically radiates from the neck to the shoulder, the arm, and even the fingers. The complaints that may accompany it:

Numbness and tingling in the hand and fingers
Loss of strength in the arm, loss of dexterity in the hand (such as a weakened grip)
Restricted movement and muscle spasm in the neck
Headache and, in some patients, dizziness or a sensation of light-headedness

This last item is an important point of distinction: since the neck is connected to structures that carry the head and are related to balance and posture, problems originating from the neck can sometimes produce these kinds of “upper” symptoms. In a lumbar disc herniation, on the other hand, dizziness is not an expected finding.

The Differences Between Lumbar and Cervical Disc Herniation

I summarize these differences to my patients like this: a lumbar herniation tests you with movement, a cervical herniation with posture. If we gather the main differences:

The direction in which the pain radiates: In a lumbar herniation the pain travels down the leg; in a cervical herniation it shoots into the arm. This is the most important first clue in the diagnosis.
The location of the numbness: In a lumbar herniation, the leg and foot; in a cervical herniation, the arm, hand, and fingers.
Frequency: Lumbar disc herniation is seen markedly more often than cervical disc herniation.
The situations that strain you: With a lumbar herniation, standing, walking, bending forward, and lifting heavy loads become difficult. With a cervical herniation, desk work, driving, and using the arm are affected more.
Additional symptoms: Dizziness and headache can accompany a cervical herniation, while they are not expected in a lumbar herniation.
Proximity to the spinal cord: This is perhaps the most critical difference. In the neck region, the spinal cord passes directly through; in the lower part of the lumbar region, however, the spinal cord has ended, giving way to a bundle made up of nerve roots. For this reason, cervical herniations require more careful follow-up in certain situations.

So which one is “worse”? There is no clear answer to this; it varies from person to person. What matters is to read the symptoms correctly and evaluate them without delay, whichever herniation it may be.

What Causes Lumbar and Cervical Disc Herniation?

At the root of both herniations lies age-related disc wear (degeneration). However, some factors markedly accelerate this process:

A sedentary life and weak core muscles: When the muscles that support the spine weaken, the load falls directly on the discs.
Sitting with poor posture for long periods: Desk work is one of the greatest strains for both the lower back and the neck.
Looking at a screen with the head bent forward: Especially for the neck, this is the most important cause of recent years.
Lifting loads heavily and with improper technique: The situation that strains the lower back the most.
Excess weight: It increases the load on the spine.
Smoking: It accelerates wear by disrupting the nourishment of the disc.
Sudden twisting and straining movements, traumas.
Genetic predisposition.

Since the spine is a whole, I would also like to point out that the same bad habits can prepare the ground for both the lower back and the neck at the same time. For this reason, herniations can be seen in both regions at once in some patients.

How Is the Diagnosis Made?

The diagnosis never relies on a single test. First, I take a detailed history and perform a neurological examination; the line along which the pain radiates, the location of any loss of sensation, muscle strength, and reflexes are evaluated. This stage most often largely reveals which level the herniation originates from.

The most valuable among the imaging methods is the MRI, which shows the discs and the pressure on the nerve roots in detail. When necessary, an EMG may be requested to measure the degree of nerve damage, and an X-ray or CT to evaluate the bone structure.

However, there is a critical point here that I repeat constantly to my patients: the appearance of a herniation on an MRI is not sufficient on its own to make a treatment decision. The decision is based on the examination findings and the imaging confirming each other. We treat the patient, not the image.

Treatment of Lumbar and Cervical Disc Herniation

First, Non-Surgical Treatment

Let me say this clearly: the great majority of herniations do not require surgery. In approximately 80–90% of cases, it is possible to obtain results with non-surgical (conservative) methods. Moreover, a significant portion of herniated disc fragments are shrunk by the body over time.

The foremost non-surgical treatments are:

Short-term rest: One or two days is enough during the acute painful period. Prolonged bed rest does more harm than good; it weakens the muscles. The patient should be returned to movement gradually.
Medication: Painkillers, anti-inflammatory drugs, and, when necessary, muscle relaxants.
Physical therapy and exercise: The most important pillar of the treatment. Individually tailored programs that strengthen the lower back and abdominal muscles, or the neck and back muscles.
Ergonomic adjustments: A correct sitting arrangement, bringing the screen to eye level, choosing a suitable pillow.
Lifestyle changes: Weight control, quitting smoking, regular conditioning exercise such as walking or swimming.
Interventional pain treatments when necessary (such as injections).

An important caution here: an exercise that is appropriate for the lower back may not be appropriate for the neck. Movements aimed at the wrong region can do harm rather than good. That is why the program must be determined together with a physician or physiotherapist who evaluates you.

When Does Surgery Come into Consideration?

The decision for surgery is made not according to the size of the herniation on the MRI, but according to the patient’s clinical picture. I generally recommend surgery in the following situations:

Severe pain that does not go away despite an adequate period of non-surgical treatment and that impairs quality of life
Progressive muscle weakness in the arm or leg
Emergency situations such as the disruption of bladder and bowel control
In a cervical herniation, findings of pressure on the spinal cord (myelopathy)

There is a difference between the two regions in surgical techniques as well. In a lumbar herniation, microdiscectomy — generally performed from the back, through a small incision — is applied, and fusion (fixation) is most often not needed. In a cervical herniation, on the other hand, the approach is generally from the front; the herniated disc can be removed and fusion achieved by placing a cage in its stead, or, in suitable patients, a disc prosthesis that preserves motion may be preferred. Which method is appropriate for you can only be decided after a detailed evaluation.

Symptoms for Which You Should See a Doctor Without Delay

Most herniations improve over time with appropriate treatment. However, some symptoms require emergency evaluation. If one of the following is present, please see a doctor or go to the nearest emergency department without delay:

Inability to control urine or stool, incontinence, or loss of toilet control
“Saddle”-shaped loss of sensation in the buttock, anal, and inner-thigh area
Suddenly developing and progressive marked loss of strength in the legs or arms
Loss of dexterity in the hands (difficulty with fine tasks such as buttoning or writing), impaired balance, unsteadiness when walking — these may be related to pressure on the spinal cord in the neck and should be taken seriously
Unbearable pain that does not go away with rest and wakes you from sleep at night

In addition, I recommend that you see a doctor for lower back or neck pain that lasts longer than 48 hours and does not go away with simple painkillers.

What Can You Do to Protect Yourself?

Protecting the health of the spine is far easier than treating it. The main headings I recommend to my patients:

Move: Regular walking, swimming, or light jogging. Inactivity is the spine’s greatest enemy.
Strengthen your muscles: A strong core (back-abdomen) and neck-back muscle group is your spine’s natural corset.
Lift correctly: Lift weights not by bending at the waist, but by bending your knees and standing close to the load.
Bring the screen to eye level: Avoid looking at the phone and the computer with your head bent forward.
Take breaks: Do not sit in the same position for long periods; get up and take a short walk every half hour.
Use a suitable mattress and pillow: Avoid sleeping face down; prefer lying on your back or your side.
Get your weight and smoking under control.

Frequently Asked Questions

Below, I have gathered the most frequently asked questions on this subject along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by the doctor who examines you.

What is the difference between a lumbar and a cervical disc herniation?

The basic mechanism is the same; the difference is in the region. In a lumbar herniation the pain radiates from the lower back to the hip and the leg; in a cervical herniation it shoots from the neck to the shoulder, the arm, and the fingers. Numbness, in parallel, is seen in the leg in a lumbar herniation and in the hand in a cervical herniation.

How are lumbar and cervical disc herniation distinguished?

The most important clue is the direction in which the pain radiates: pain travelling down the leg suggests the lower back, while pain shooting into the arm suggests the neck. Dizziness and headache can accompany a cervical herniation, while they are not expected in a lumbar one. The definitive distinction is made with an examination and, when necessary, an MRI.

Which is more dangerous: a lumbar or a cervical herniation?

There is no clear answer to this; it varies from person to person. Because the spinal cord passes directly through the neck region, more careful follow-up may be needed in certain situations. A lumbar herniation, on the other hand, can seriously reduce quality of life. What matters is to evaluate the symptoms in good time, whichever it may be.

Can a lumbar and a cervical herniation occur at the same time?

Yes, it is possible. The spine is a whole; poor posture, inactivity, and improper habits of use can prepare the ground for both the lower back and the neck region at the same time. In this case, each region needs to be evaluated separately.

Do lumbar and cervical herniations resolve without surgery?

Most often, yes. In approximately 80–90% of cases, results are obtained with non-surgical methods such as rest, medication, physical therapy, and exercise. Surgery comes into consideration in cases of severe pain that does not go away, progressive loss of strength, or emergency situations.

Are the exercises for lumbar and cervical herniation the same?

No. Although the basic logic is similar (strengthening the muscles, supporting the spine), the programs differ. A movement suitable for the lower back may not be suitable for the neck; it may even do harm. That is why the exercises must be planned together with a physician or physiotherapist.

Does a cervical herniation cause dizziness?

In some cervical herniation patients, headache, dizziness, a sensation of light-headedness, or balance problems can be seen. However, dizziness also has many other causes; for this reason it would not be correct to attribute it to a cervical herniation on its own, and an evaluation is essential.

Which department should I go to for a herniation?

The two branches that most often play a role are Physical Medicine and Rehabilitation and Brain and Nerve Surgery. For mild to moderate complaints, the first step is usually physical therapy; if there is severe pain radiating into the leg or arm and loss of strength, brain and nerve surgery should be consulted.

Disclaimer (Legal Notice)

The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The course of a lumbar or cervical disc herniation, its appropriate treatment, and the recovery process vary from person to person according to the degree of nerve compression, the severity of the complaints, and the person’s general state of health, and can only be determined by a doctor who evaluates you. If you have a complaint or before making any decision regarding your health, always consult a specialist physician. In the case of emergency symptoms such as urinary/bowel incontinence or sudden and progressive loss of strength, go to the nearest healthcare facility without delay.