Sciatica Or Disc Herniation Explained By Spine Surgeon: What’s Actually Causing Your Leg Pain?

Added: 2026-05-10

[00:00:00]Do you have sciatica? Do you have pain in your legs related to the disc in your back? We're gonna talk about that today.

[00:00:04]Welcome to Talking with Docs. I'm Dr. Brad.

[00:00:06]>> I'm Dr. Paul Salza.

[00:00:08]>> We got a guest.

[00:00:08]>> And I'm Dr. Brian Drew, spine surgeon from Hamilton. We used to train together. We brought him out here to give all of his expertise about disc herniations.

[00:00:15]>> And we made a video about back pain with a guy who looks just like you.

[00:00:19]>> Yeah.

[00:00:19]>> Actually sounds like you.

[00:00:21]>> He was better looking though.

[00:00:22]>> Yeah, I think so.

[00:00:23]>> We talked about back pain. We talked about sort of non-specific back pain, generalized back pain. Uh, and one thing we mentioned that we weren't going to talk about in that video was a disc herniation. So, here we are to talk about disc herniation. Now, I I'd like to know what is my disc? All right. Uh, how does it herniate or what does that mean when it herniates? What are my symptoms going to be? What are my treatment options? And how common is this? So, there there are disc herniations present in different ways.

[00:00:51]We we talked about back pain before and you can have an acute disc herniation from lifting something heavy. Um often it's you know bending forward types of activities increase the risk of having uh a disc problem. However, as we age we get disc protrusions and degeneration in our disc.

[00:01:14]>> Okay, >> that happens to everybody and causes back pain. Your disc is is between your vertebrae. So the vertebrae are your bones. The disc is a puckshaped soft tissue structure with ligament around the outside and a little jelly piece on the inside jelly donut >> all the way from the base of our skull right to our tailbone >> between every vertebrae right from your neck, your middle back, your lower back has a disc between each bone. So there's lots of them in there.

[00:01:39]>> So we have cervical discs in the neck, thoracic discs in our abdomen and our chest. Yep.

[00:01:44]>> And then our lumbar discs which are by far the most common that get herniated.

[00:01:48]Correct.

[00:01:48]>> Yeah. Yeah. Okay. We don't see it too much in the thoracic spine. The neck is less common but still not uncommon.

[00:01:54]>> And what does herniation mean? What's the word herniation mean?

[00:01:57]>> So the the little ligaments on the outside or the annulus of the disc th those can start to weaken and tear and then that jelly substance on the inside starts to leak out and bulge. That could just cause back pain and that's it.

[00:02:10]Behind the disc is our spinal column where our nerves run down and then exit between each of the bones and run down our legs.

[00:02:19]>> Right?

[00:02:20]>> Uh if the disc gets big enough and starts to pinch or compress one of those nerves, then it sends symptoms into the leg. That can be either pain, numbness or tingling, so some change in your sensation and or a change in your motor function i.e. weakness of a certain muscle group. So, we have kind of a like a like we have a fuse box in our home and we know this this fuse goes to the bathroom, this goes to the bedroom, this goes to the fridge. Between each vertebrae, we know where the nerves run.

[00:02:53]So, some run run run to our hip to the to our quadriceps or the front of our our uh leg. Some run down lower to the front of our to our calf or the front that lifts up our foot. So, they're all different nerves that do different things. So based on the patient's symptoms, we can get a rough idea of maybe where this problem is coming from.

[00:03:13]>> And this is where our viewers will hear like, I have an L1 hernia or I have an L4 herniation or an S1 herniation. That talks about the specific nerve, the root that's going through that little hole and getting pushed off, >> right? And and and they'll often have two. They'll say it's an L45, >> right, >> disc and it's hitting the L5 nerve. So we're getting too technical here, but basically the disc is between the two vertebrae. So it gets named by the vertebrae above L4, the vertebrae below L5. So that disc is the L45.

[00:03:42]>> Got it.

[00:03:42]>> disc.

[00:03:43]>> Okay.

[00:03:44]>> Okay. I love that analogy of the fuse box. And so how and I mean that overlaps into our world where we sort of are replacing hips and knees and people come in complaining of pain because the idea with this is you could be having pain in your thigh, your knee or your foot. And there's nothing wrong with your thigh or near your foot. The problem is up around the disc in your back. It's like with your fuse box or you want to turn the lights on in the kitchen, they're not coming on. You can change that light bulb a thousand times, but it's not going to work till you fix the fuse box.

[00:04:10]And we run into that problem sometimes with knees, you know, we replace someone's knee, they're like, "Oh, I still have pain. Stop pain." And it could be a problem coming from the spine. And we call that like, you know, that's a ridiculopathy where you feel it away from where it's happening.

[00:04:24]>> Um, correct.

[00:04:24]>> Okay. So, this and so the disc is pushing on the nerve. You're going to feel either weakness, numbness, or um pain. pain in in the nerve that's being pinched way above and you're going to feel it far away from your back. So, who gets this? Is this common in like kids?

[00:04:40]Is it common in middle age? Is it common in elderly people?

[00:04:43]>> So, yeah, rare in kids. So, you know, under 20, it's it can happen as a teenager, but but pretty rare. Once you hit sort of 20, 25, it starts to to spike up. So, very common in the 30s, 40s. You can get it in your 50s as well.

[00:04:59]And then over time our discs they'd kind of dry out a little bit and and lose some height and there's a generalized bulge. So if you were to MRI you know 100 20 year olds than 30 40 50 60 and they never had any back problems or leg problems they're going to show stuff on their MRI disc bulges etc. >> Right? That's normal. Uh, as we age, just like if we took a picture of you when you're 20, 30, 40, 50, 60, you're going to look different.

[00:05:32]>> Okay? So, just like so so those kind of things are going to happen to everybody.

[00:05:37]But a disc herniation, pinching a nerve causing sciatica starts to drop off as we as we age past 50 or 60.

[00:05:44]>> There you go. For everyone who says it's no fun getting old, here's something you can brag about, you know, >> till we talk about spinal stenosis.

[00:05:51]>> Well, that's another video. For this video, >> Dr. Downer, >> that's right. Okay. So, so people show up. So, let's talk about their symptoms specifically. So, most commonly, are people going to come in and say, "I have I have pain in my legs." So, say we're talking about the lower part of our lumbar spine. Most common disc L45 and 51 would are they responsible for 80% of discarnation?

[00:06:09]>> Yeah. Most most of them are in the the two lower levels are the most common. It can happen at at any level, but most common in those bottom two.

[00:06:15]>> So, they're showing up with pain like in their buttock, their back of their leg, right down their foot.

[00:06:18]>> They'll say, "My butt." It'll be down the back or side of their thigh and then below their knee, kind of in their calf or the side of their their calf, and it can go into the foot.

[00:06:27]>> You can just have pain. Uh you can have pain and numbness. You can have pain, numbness, and weakness. It can be a combination of those three. Anything that makes it better or worse typically are things that you ask people like when you're asking people the story to find out if it's a disc.

[00:06:41]>> Bending forward types of activities tend to tend to aggravate disc. Coughing, sneezing will aggravate discs uh and and increase their leg symptoms, >> right?

[00:06:52]>> Okay. So, we we know those are those are that's sort of the age group that you get it. Those are the symptoms. Can we go to what should we do about it at this point? Treatment options kind of thing.

[00:07:03]>> Yeah. Yeah. Uh, so initially you don't have to run out and get an MRI right away.

[00:07:08]>> Oh, that's a good point.

[00:07:09]>> The good the good news with discs, if you if you were to come and see me in the first week, I'd say, "Hey, don't worry. 90 95% of people are going to get better."

[00:07:19]>> Okay, >> that's that's the good news. Great news.

[00:07:21]>> With the passage of time, some rehabilitation, as we talked about before, physiootherapy, chiropractic treatment, osteopathic treatment, um, >> you you can seek out those professionals. are well verssed in in dealing with that acute episode and getting you through it. And it's just unfortunately kind of sucking it up because it it hurts. I've had women say, >> "I've given natural child birth, right?

[00:07:45]>> And I'd rather do that than have sciatica."

[00:07:47]>> Okay.

[00:07:48]>> Okay.

[00:07:48]>> Right. Like it it is painful, therefore scary. And people go to the emerge >> and and and panic and and want all these investigations right away. But rest assured, most people will settle down over time. A small percentage don't, and we have to manage those differently, which we can talk about.

[00:08:06]>> And that's because that disc is slowly receding, right? So, it's pushing on the nerve. Our nerves are very sensitive.

[00:08:10]They don't like to be touched, let alone barely looked at, and they're very sensitive. So, as that regresses, that nerve gets really about blood supply to the nerve, right? So, normal blood supply is restored to the nerve, so it's less irritated. And then those symptoms slowly reced.

[00:08:22]>> Yeah. The the the disc will shrink. It doesn't slip back into position, but it'll it'll resorb and shrink over time.

[00:08:28]the pressure gradually comes off the nerve and you have a slow gradual improvement in your leg symptoms.

[00:08:33]>> Now you mentioned MRI. So the workup for this typically so you do a history and physical examination when you see these patients. You'll check uh reflexes, check the nerve functions and things like that to help determine clinically where things are going on and presumably you get an X-ray of the back every time.

[00:08:48]>> Yeah, you can uh it could be helpful to rule out certain degenerative conditions. Um, but an an MRI is probably going to be the best test if you're having leg pain that's not getting better. It's not a good test or investigation if you just have back pain, >> right?

[00:09:05]>> Because as we said, as we age and we have the outside of our body changes, the inside of our body is changing and you see a whole bunch of stuff that panics patients, >> right?

[00:09:15]>> And those are there in patients >> who don't have any back pain. If we were to MRI 150 year old guys, they're going to have a whole bunch of stuff on their MRI that's going to scare them.

[00:09:24]>> Okay.

[00:09:25]>> So, MRIs for back pain, >> not not a great test. When it's a leg pain and we do our, you know, we we touch them and see where their where their numbness is. If they've losing a reflex or have some weakness in a muscle that's suggesting a nerve problem, their pain's not getting better, then the MRI will tell us exactly is it the S1 like you said, is it the L5? and then that can give us a little bit more information. It doesn't change the initial management, but it helps confirm the diagnosis.

[00:09:54]>> So, to your point, you don't have to go to the ER, the walk-in clinic. So, this is appropriate to wait to see your family, call your family doctor, right?

[00:10:00]I mean, obviously, if your pain's uncontrolled, then that's a very individual situation. So, you see your family doctor, your family doctor does those exams, does maybe does an X-ray.

[00:10:07]Um, does not necessarily order an MRI away. And then, so then you that person says, "Okay, well, I'm going to I'm happy to listen to you." I wait my six weeks or whatever and I'm I fall into that small group of people that does not get better. They're back at their family doctor. At what point does a family doctor then a order an MRI or b when does someone come see a surgeon? When does this become more serious regardless of the time frame that now we're like, okay, well, this is not your run-of-the-mill disc and this is something we're going to need to do something about.

[00:10:33]>> Yeah. So, yeah. So, they're they're the leg pain is remaining.

[00:10:36]>> Y >> uh and not really improving very quickly, then at least ordering the MRI, there's going to be a bit of a wait for that unfortunately. Uh but getting that test done is um appropriate. If it's showing pressure on a nerve and you're not getting better, uh then getting referred to a surgeon is reasonable. Um certain types of pain clinics can there are epidural injections that can sometimes be helpful. It's not always a permanent solution, but sometimes it can drop your pain significantly to allow you to be more comfortable while you're waiting for the passage of time for that disc to slowly improve over time. You're just managing your pain better while the natural history of the recovery is occurring.

[00:11:23]>> Okay?

[00:11:23]>> All those things are failing then seeing a spine surgeon uh unfortunately at that point in time is probably the right thing to do. there is a good surgical solution for disc herniations.

[00:11:35]>> What? Okay, you're waiting that time, but what if there's like what if I had a foot drop or like muscle weakness?

[00:11:41]>> And I'm like, isn't it better for me to get that treated sooner so that I have a better chance of >> because you can appreciate the anxiety of the patient who used to be able to move their foot now like this it's going to be fine. It's going to be fine. And now I got this foot.

[00:11:53]>> Yeah. So if there's a significant motor deficit like like that of particularly of a very important muscle like being able to lift your foot up or extend your knee up that is a huge difference in your ability to walk which we all need to do obviously.

[00:12:07]>> Uh so that's really more of a uh an urgent situation.

[00:12:12]>> Okay. And and that may may need the family doctor calling the spine surgeon on call or calling their their calling their office to say, "Hey, can you expedite this? This is >> this is this is what's happening."

[00:12:25]>> Okay.

[00:12:26]>> Yeah.

[00:12:26]>> If there's a motor motor weakness, >> a significant motor >> motor deficit or or weakness of an important muscle in your leg, then that should be seen much quicker.

[00:12:35]>> And the main reason timing is important there is because the longer it goes, the higher the chances you get an incomplete recovery. Is that >> Yeah. cuz you're pro that's probably something where we're going to push surgery and recommend surgery and then not >> I'll see you back in 4 months at the end of my weight list. You're going to push that up uh right away and and do that as an urgent uh procedure to try to improve the outcome i.e. get that motor function back.

[00:12:58]>> And the thping that happens is because the motor fibers are deeper inside the nerve, right? So the sensory ones are essentially on the outside. So they get irritated very quickly.

[00:13:04]>> So you get pain and numbness but not weakness.

[00:13:06]>> But then the bigger the disc and the longer the pressure, that's when the motor comes later.

[00:13:10]>> Okay.

[00:13:10]>> Yeah.

[00:13:11]>> Okay. So now we've talked about the non-operative management. Most of the time this gets better. Thank God.

[00:13:18]Sometimes it doesn't. Or you have a significant motor issue. What does the surgery look like? What are we doing here? Are we pushing that disc back in place? Are we taking it out, throwing in the garbage? What are we doing with this?

[00:13:28]>> Yeah, there's >> nemesising disc.

[00:13:30]>> Yeah. No, there's there's the the operations are basically the same.

[00:13:34]There's different ways of doing it.

[00:13:36]Over, you know, several decades. The the operation has gotten smaller. So, incision size are smaller. There are more um microscopic minimally invasive ways of of getting in there. So uh but basically we have to get through the muscle in your back onto the back of the spine where there's a bone there called your lamina. We've removed part of that and then we can see the nerve >> like a door or a window essentially.

[00:14:00]>> Yep. We're we're making a we're making a window where there's a wall.

[00:14:04]>> Y >> uh then we're inside. We see the nerve.

[00:14:07]We can't see the disc.

[00:14:08]>> Okay.

[00:14:08]>> We move the nerve out of the way. Then the disc is sitting right there. And we just cut the part of the disc that's sticking out. We want to leave the rest of the disc there. It's there for a purpose. When we remove that part that's sticking out, we then let we just let the nerve fall back into position >> and sew you up. And it's for most people, it's a day procedure. So, you can come in, have that operation, go home the same day, unless you have some medical issues that need to be monitored.

[00:14:34]>> And and this procedure is not exploratory. You know, exact you essentially have a very good idea of what you're going to find, right? You very specific area. So, that's what makes it so successful.

[00:14:42]>> Yeah. And and that's where the MRI is helpful, right? So we know exactly where we're we're going. When we have positioned the patient on the table, we bring in an X-ray or a floroscopes so and put a little marker so we know exactly where we're going. And once we open you up, we check double check again >> because all the vertebrae look exactly the same when you when you get in there.

[00:15:01]So you got to make sure you're at the right spot. So we're really uh it's really important to to to do that and and all surgeons are quite focused on making sure we're in the right spot.

[00:15:09]>> Okay. And whenever we talk about a surgical intervention, we always like to discuss, well, we don't like to, but we know we have to discuss the risks. So, bad things can happen whenever we do surgery. What are some of the risks associated with this kind of a surgical procedure?

[00:15:21]>> So, yeah, with with all surgeries, you know, we're opening you up. So, there's an infection uh risk. We give patients some antibiotics before and sometimes after the operation to reduce that risk, but we can't make it zero, >> right?

[00:15:34]>> The number one thing people are worried about is, am I going to wake up and be in a wheelchair? or am I going to have a a a paralysis of some nerve injury type of nerve injury?

[00:15:42]>> Fortunately, that's very very rare.

[00:15:44]>> Okay.

[00:15:45]>> Yes, we have to move the nerve out of the way. So, moving that out of the way can irritate the nerve and >> maybe cause some mild transient numbness or or some weakness when you wake up, but that's that's pretty pretty rare and that goes away. But because they're sharp tools that we're using, if something unfortunately was we're humans, if something was to slip or break and and cut a nerve, that could cause significant weakness of a specific muscle that that nerve goes to. That is extremely rare, like way less than 1%.

[00:16:16]>> Y >> okay.

[00:16:18]>> Um, bleeding happens with everybody when we do surgery. It would be very very rare to need a blood transfusion. The bleeding with this is is very minimal.

[00:16:27]Scar tissue forms with every operation we do. Just like you there's some a scar on your skin. There's scar inside where the where you did the operation. In rare cases uh excessive scar tissue can form and you feel better after the operation and as the scar tissue builds up uh that can put pressure on the nerve again and cause some chronic leg pain after uh after surgery.

[00:16:52]>> Okay. Tear of the dura. Is that still a thing? I remember in residency >> that's a thing it frustrating to the surgeon usually thankfully most patients don't even know it it happens because we recognize it at the time >> so it's not really a nerve injury our our nerves run inside think of it like running inside a hose >> and then you accidentally cut the the top of the hose but you don't hit any of the the structures inside it's super thin uh we see it your your spinal fluid leaks out we see it at the time and usually it's just a couple stitches in there and that seals it up and then the patient doesn't know.

[00:17:29]Unfortunately, it can happen late. So, the next day or a week or two after the where we where we made that window, there can be some kind of rough edges and the dura, you know, you bend a certain way or you cough and then the the dura hits that little rough end and it cuts it.

[00:17:46]>> And then if your wound is still open, all of a sudden there's basically it looks like water coming out of your your wound, >> right? If your wound is and you and you get a headache because you're losing fluid. If your wound is healed up when it happens, then nothing leaks out, but then all of a sudden you have this horrible headache, right?

[00:18:04]>> And when you say patient doesn't know, we mean you won't when it happens interoperatively and we deal with it interoperatively. It means you didn't you won't have any symptoms from it, but your surgeon will say, "Hey, we're doing it. You had a little dural tear. We had to put some stitches in to fix it." But by doesn't know, you mean they're asymptomatic.

[00:18:18]>> They wouldn't have any symptoms from it.

[00:18:20]Maybe if if a lot of fluid came out, they may wake up with a headache, but that that would go away quickly.

[00:18:24]>> All right. There.

[00:18:25]>> And I guess the last thing, success rates, does it work?

[00:18:28]>> Yep. Good success rate. There's lots of studies out there uh that shows leg pain improves significantly with the operation.

[00:18:37]>> Back pain doesn't improve so well. So, when we're selecting patients, surgeons like to say have the patient say, "I don't really care about my back pain.

[00:18:46]It's my my leg." That's that's my problem doctor cuz occasionally people have a disc herniation. They have mostly have back pain minimal leg pain. We try not to operate on those people because the back pain doesn't get better >> because back pain is so multiffactorial as we talked about in our previous video. So you can imagine that a surgical treatment is unlikely to help the back pain aspect of things.

[00:19:07]>> Correct. Fortunately, the leg pain tends to get better quickly to your question.

[00:19:11]It can get better. Occasionally they wake up and it's like ah I'm better. Uh but generally it's over several weeks of slow gradual improvement. So pretty quick.

[00:19:20]>> Yeah.

[00:19:20]>> The numbness part, the sensory symptoms or your weakness that takes a long time.

[00:19:26]And a little more that that can be a year.

[00:19:28]>> Yeah. Oh wow.

[00:19:28]>> Because the nerve sometimes has to regenerate and and and grow back and that's a slow >> uh process. But most patients are like thank god the pain is better. Uh and then you just have to educate them. It's going to take some time uh maybe some rehab to to work on the motor deficit.

[00:19:44]>> Awesome. All right. Who knew discs would be so fascinating?

[00:19:47]>> Yes.

[00:19:48]>> So, hopefully you've watched our other video on sort of generalized back pain and then now we just sort of focused a little bit on the disc herniation aspect of that general back pain, which is of course rare in the general back pain population. Uh, but thanks so much for sharing that wisdom with us. No problem.

[00:20:03]>> Sure. And if you like this video, please like it, subscribe to our channel, share it with someone that you know has a herniated disc. And uh if you've had experience with a herniated disc and surgery or non-surgery or whatever you went through to to get it working again, leave a comment so others can benefit from your experience. Remember, you are in charge of your own health. We'll see you next time.