Painless weakness from lumbar disc herniation: Recommended management and outcomes

The objective of this article is to review the pathogenesis, presentation, and treatment options for patients with painless weakness due to lumbar disc herniations. Pain is the most common complaint among patients with symptomatic lumbar disc herniations. Painless weakness is another possible presentation. The absence of pain presents diagnostic challenges in that many other etiologies can manifest as lower extremity weakness. Painless weakness raises therapeutic uncertainties for both nonoperative and operative interventions. In conclusion, as in its more common painful presentation, lumbar disc herniation causing painless weakness has an overall good prognosis. Surgeons must be aware of several factors that may influence surgical outcomes. Early surgical treatment should be considered for patients with nerve compression and significant or progressive weakness.