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Lumbar Disc Herniation Diagnosis

Epidemiology, clinical and radiologic diagnosis | WFNS spine committee recommendations


Low back pain (LBP) is more common in adults than most people realize, with more than 60 percent of adults reporting back pain at some point or the other in their lives. However, in less than 5 percent of cases is disc disease responsible for this pain.1

Initially, herniation, which is the displacement of intervertebral disk material beyond its normal boundaries, was referred to as disk rupture. Today, lumbar disc herniation is believed to occur when disc material is displaced and extends beyond the normal boundaries of the intervertebral disc space, leading to symptoms such as pain, weakness, or numbness in specific muscle or skin regions.

Previous studies show that lumbar disc herniation diagnosis occurs more frequently in the third to fifth decade of adult life, and it happens twice as much in males than females. This article is a summary of a study on lumbar disc herniation. The goal of the study2 was to produce the latest evidence-based recommendations for the epidemiology, clinical, and radiographic diagnosis of lumbar herniated disc (LHD). These recommendations must be considered credible because they came to be based on the consensus of the World Federation of Neurological Surgeons (WFNS). The study considered the estimated incidence and lifetime risk of lumbar herniated disk, as well as specific age groups, genetic factors, gender, occupations, and medically relevant activities or habits that contribute to the development of LHD. The study also defined how pain is assessed in LHD patients.

lumbar disk herniation model


Research Process

Study selection

Credible electronic scientific databases were searched between 2012 and 2022 for a wide variety of terms related to different diagnoses of lumbar herniated discs. 17 studies were selected from 1047 articles for epidemiology and prevention, 16 studies were selected from 4656 articles for clinical diagnosis of LHD, and 3370 articles were also initially obtained for radiological diagnosis. A total of 90 studies were selected in the final analysis.


Consensus Meetings

The WFNS over the course of two meetings finally voted on 11 revised statements. They used the Delphi method to generate their consensus statements. Scores 1, 2, and 3 represented agreement, and scores 4 and 5 represented disagreement. According to how respondents scored each statement, consensus statements were derived by selecting statements that had agreement or disagreement at 66 percent or above.


WFNS Recommendations

Based on the information garnered from studies that were selected, respondents in the spine committee considered scientific literature as regards the epidemiology of LHD, clinical diagnosis of LHD, and radiology diagnosis of LHD, and the following recommendations were proposed by the spine committee after they came to a consensus, as the guidelines for practicing spine surgeons worldwide.


  1. The lifetime risk for lumbar disc herniation is about 30%. Symptomatic disc herniation risk is 1–3%; of these, 60–90% resolve spontaneously.
  2. Risk factors for lumbar disc herniation include genetic and environmental factors, strenuous activities, and smoking.
  3. Radicular pain with specific dermatomal radiation in one or both legs is usually associated with a herniated disc.
  4. Pain history is the most important part of clinical evaluation. It should include questions on intensity, onset, and localization. Pain should be assessed with a visual or numeric analogue scale and Oswestry disability index.
  5. Essential diagnostic tests in patients with a suspected herniated disc are the evaluation of muscle strength, sensory disturbance, and sphincter dysfunction, as well as the supine straight leg raise, Lasegue sign, and crossed Lasegue sign.
  6. Muscle strength testing should be examined and documented using the MRC (Medical Research Council) scale (0–5).
  7. Lumbar facet blocks are the gold standard for diagnosis of facet joint syndrome.
  8. There is no convincing evidence for lumbar discography in the diagnosis of discogenic pain.
  9. When patients present with symptoms consistent with lumbar disc herniation without neurologic deficit, radiological assessment is suggested for persistent pain after 6–12 weeks. An earlier radiographic investigation is recommended if a motor deficit is present.
  10. Magnetic Resonance Imaging (MRI) is the most appropriate non-invasive test to confirm the presence of lumbar disc herniation.
  11. Plain X-ray images should only be considered as an adjunct imaging modality to differentiate lumbar disk herniation from other lumbar pathologies.



The 11 statements presented serve as the latest evidence-based guidelines for spine surgeons worldwide, encompassing the epidemiology, clinical diagnosis, and radiographic diagnosis of lumbar disc herniation (LDH). These guidelines are particularly pertinent for practicing surgeons in low and middle-income countries. 

To recap, Lumbar disc herniations (LDH) occur when disc material is displaced beyond the normal boundaries of the intervertebral disc space, leading to symptoms such as pain, weakness, or numbness in myotomal or dermatomal distribution. Mostly, symptomatic LDH resolves on its own with a bit of rest, but risk factors including age, male gender, smoking, strenuous activity, and smoking can play a significant role in recovery.


At Dynamic Disc Designs we have worked to bring accurate modelling to the spine professional to aid in the teaching of conditions like disc herniation. Explore our growing line of realistic anatomical models.