Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
“My back hurts and the pain shoots into my leg; which doctor should I see?” This is one of the most frequently asked questions in the healthcare system and one that confuses patients the most. Brain surgery? Physical therapy? Neurology? Orthopedics? The truth is that the evaluation and treatment of a lumbar disc herniation involve more than one specialty; which department is the right one varies according to the severity of your complaints and the stage you are at. In this article, I explain in plain language which department you should consult in which situation, the role of each department, and the confusions you may encounter.
Which Department Should You Go to for a Lumbar Disc Herniation? The Short Answer
Let us begin with a direct and clear answer: the two main branches that most often play a role in lumbar disc herniation are Physical Medicine and Rehabilitation (PM&R) and Brain and Nerve Surgery (Neurosurgery). Departments such as neurology, orthopedics, and pain medicine (algology) may also accompany these depending on the situation.
To summarize roughly: if your complaint is mild to moderate, the first step is usually physical therapy; if there is severe pain radiating into the leg, progressive weakness, or the question of whether surgery is needed, then brain and nerve surgery comes into play. What matters is not seeking out a single department, but having the correct evaluation and, when necessary, the referral between departments carried out.
The Departments Involved in Lumbar Disc Herniation and Their Roles
Knowing which department does what largely resolves the confusion.
Physical Medicine and Rehabilitation (PM&R)
This is the branch at the center of the non-surgical treatment of lumbar disc herniation. The great majority of patients benefit from PM&R. The physical medicine specialist creates an exercise program, arranges physical therapy sessions when necessary, manages chronic low back pain, and oversees the post-operative rehabilitation process. It aims to increase the stability of the spine by strengthening the back and abdominal muscles, and to return you to your daily life.
Brain and Nerve Surgery (Neurosurgery)
This is the main branch consulted for the definitive diagnosis of a lumbar disc herniation, the evaluation of whether surgery is needed, and performing the surgery when necessary. Neurosurgeons are the specialists who carry out all surgical interventions related to the spine and spinal cord. The most reliable answer to the question “There is a herniation on my MRI, will I need surgery?” is obtained from this department. When necessary, the pressure on the nerve is relieved with microsurgical (microdiscectomy) or closed (endoscopic) methods.
Neurology
Neurology is the branch that diagnoses diseases of the nervous system and treats them with medication; it does not perform surgery. Its most important contribution in lumbar disc herniation is determining the level and degree of nerve damage with EMG (electromyography). It is also valuable in answering differential-diagnosis questions such as, “Do these complaints stem from a lumbar disc herniation, or from another cause such as nerve damage due to diabetes, carpal tunnel syndrome, or a cervical disc herniation?”
Orthopedics and Traumatology
The role of orthopedics in lumbar disc herniation is more limited, but it is important in certain situations. It comes into play in conditions such as spinal curvatures (scoliosis), slippage of the spine (spondylolisthesis), spinal fractures, and bone loss (osteoporosis). Sometimes an orthopedic evaluation can reveal that pain thought to be a lumbar disc herniation actually originates from the hip joint. In addition, some orthopedic specialists are experienced in spine surgery and can perform lumbar disc herniation operations.
Pain Medicine (Algology)
Algology is the branch focused on the management of pain. Particularly when interventional methods (such as injections) come into consideration, it can contribute to pain treatment in selected patients.
Which Department Should You Go to According to Your Complaint?
To provide a practical roadmap, the general approach that can be followed is as follows:
- Mild to moderate low back pain, mild numbness: The first step is usually Physical Medicine and Rehabilitation. The great majority of these cases are treated successfully with non-surgical methods.
- Severe pain radiating into the leg, numbness, or progressive loss of strength: You should consult Brain and Nerve Surgery.
- Only low back pain, not radiating into the leg: An evaluation can be obtained from physical therapy or brain and nerve surgery.
- If the degree of nerve damage needs to be measured or differential diagnosis is required: Neurology (for EMG).
- If a spinal curvature, slippage, or fracture is suspected: Orthopedics and Traumatology.
Going to a family doctor at the first visit and obtaining a referral is also a perfectly reasonable starting point. Whichever department you go to, your doctor will refer you to the right specialist when necessary.
“Does Going to a Neurosurgeon Mean I Will Have Surgery?”
This is the subject patients fear the most and misunderstand the most; that is why I particularly want to emphasize it. No. Consulting brain and nerve surgery does not mean you will have surgery. The great majority of lumbar disc herniations — generally about 80–90% of patients — recover with non-surgical methods such as rest, medication, physical therapy, and lifestyle adjustments. As a neurosurgeon, my priority, too, is always the non-surgical options in suitable patients. Surgery comes into consideration only in cases of severe pain that does not go away despite an adequate period of treatment, progressive muscle weakness, or emergency situations.
See a Doctor Without Delay in the Case of These Symptoms
A lumbar disc herniation often improves over time with appropriate treatment. However, some symptoms may be a herald of a serious condition requiring emergency intervention (cauda equina syndrome). If one of the following “red flag” symptoms appears, see a brain and nerve surgery specialist 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 or paralysis in the legs.
- Unbearable, persistent pain.
How Is the Diagnosis Made?
The diagnosis of a lumbar disc herniation does not rely on a single test. First, a detailed history is taken and a neurological examination is performed; the spread of the pain, the location of any loss of sensation, muscle strength, and reflexes are evaluated. 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. The critical point here is this: the mere 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 being evaluated together.
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.
Which department treats a lumbar disc herniation?
The two main branches most often involved in lumbar disc herniation are Physical Medicine and Rehabilitation and Brain and Nerve Surgery. Depending on the situation, neurology, orthopedics, and pain medicine may also be part of the process. Which department is appropriate varies according to the severity and type of your complaints.
Which doctor should I see first for a lumbar disc herniation?
For mild to moderate complaints, the first step is usually physical medicine and rehabilitation. Going to a family doctor for the first visit and obtaining a referral is also appropriate. However, if there are symptoms such as severe pain radiating into the leg or loss of strength, it is more correct to consult brain and nerve surgery directly.
Lumbar disc herniation — neurology or brain surgery?
The roles of the two are different. Neurology treats diseases of the nervous system with medication and, in particular, evaluates nerve damage with EMG; it does not perform surgery. Brain and nerve surgery, on the other hand, evaluates whether surgery is needed and performs it when necessary. If loss of strength in the leg or widespread numbness is prominent, an evaluation by both may be useful.
Does going to brain surgery mean having surgery?
No. Consulting brain and nerve surgery does not mean you will have surgery. In the great majority of patients, non-surgical treatment is sufficient; surgery comes into consideration only in certain situations.
Which doctor performs lumbar disc herniation surgery?
Lumbar disc herniation operations are performed by brain and nerve surgery (neurosurgery) specialists. In addition, some orthopedic specialists who are experienced in spine surgery can also perform these operations.
Orthopedics or brain surgery?
The main branch in the surgical treatment of lumbar disc herniation is brain and nerve surgery. The role of orthopedics stands out more in conditions such as spinal curvatures, slippages, fractures, and pain originating from the hip joint. Some orthopedic specialists, meanwhile, are experienced in spine surgery.
I only have low back pain, it does not radiate into my leg; which department should I go to?
If you have only low back pain, you can obtain an evaluation from physical medicine and rehabilitation or from brain and nerve surgery. An examination is essential for correctly identifying the source of the pain; because not every instance of low back pain is caused by a herniation.
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 correct department and treatment approach for a lumbar disc herniation vary from person to person according to the severity of the complaints, the accompanying symptoms, and the patient’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 loss of strength, go to the nearest healthcare facility without delay.