Diagnosis and Nonoperative Management of Lumbar Disk Herniation

Lumbar disk herniation is a common cause of low back pain in the United States. Diagnosis of lumbar disk herniation in a person complaining of low back pain depends on an understanding of anatomy and pathophysiology as well as the ability to synthesize various elements of the history and physical examination. Imaging studies should then be used to confirm and clarify the diagnosis, but it is important to acknowledge that they cannot replace the clinical picture because the high rate of asymptomatic disk herniations can be misleading. The proper nonsurgical treatment of herniated nucleus pulposus revolves around controlling symptoms to strengthen patients and restore their function, and it may involve any combination of analgesic medications, physical therapy, therapeutic modalities, and corticosteroid injections. This article aims to clarify current aspects in the diagnosis and nonoperative management of lumbar disk herniation.