Journal List > J Korean Soc Spine Surg > v.8(3) > 1035959

J Korean Soc Spine Surg. 2001 Sep;8(3):305-313. Korean.
Published online September 30, 2001.
Copyright © 2001 Korean Society of Spine Surgery
Natural History and Clinical Manifestations of Lumbar Disc Herniation
Ho-Guen Chang, M.D., and Young-Gun Lee, M.D.
Department of Orthopaedic Surgery, College of Medicine, Hallym University, Korea.

Address reprint requests to Ho-Guen Chang, M.D. Department of Orthopaedic Surgery, College of Medicine, Hallym University, #896 Pyungchun-dong, Dongan-gu Anyang City Kyunggi-do 431-070, Korea. Tel: 82-31-380-1814, Fax: 82-31-382-1814, Email:

The patient of lumbar disc herniation complains low back pain and sciatica. The intervertebral disc was degenerated by aging, the lifetime incidence of low back pain ranges from 80 to 90%, as determined by epidemiologic studies, whereas the incidence of sciatica is only 2~40%.

This article was made with review of the natural history, clinical manifestations and physical examinations of lumbar disc herniation.

In conclusion, a careful history and physical examination remain the key to accurate diagnosis of the cause of low back pain and /or sciatica, and very helpful adjuncts to make a diagnosis of lumbar disc herniations.

Keywords: Lumbar disc herniation; Natural history; Clinical manifestations


Fig. 1
Root compression according to type of herniated disc

A. Posterior herniated disc

B. Extra-foraminal herniated disc

Click for larger image

Fig. 2
A. Herniated disc lateral to the nerve root. This usually produces a sciatic list away from the side of irritated nerve root.

B. Herniated disc medial to the nerve root and in an axillary position. This may produce a sciatic list toward the side of irritated nerve root.

Click for larger image

Fig. 3
The dynamics of SLR : Observations on straight leg raising, with special reference to nerve root adhesion.
Click for larger image

Fig. 4
Movement of nerve roots when the leg on the opposite side is raised.

A. When the leg is raised on the unaffected side, the roots on the opposite side slide slightly downward and toward the midline.

B. In the presence of a disc lesion, particularly in an axillary locatin, this movement.

C. Increases the root tension.

Click for larger image


Table 1
neurologic test according to location of herniated disc
Click for larger image

1. Andersson GB, Svensson H, Oden A. The intensity of work recovery in low back pain. Spine 1983;8:880–884.
2. Berqquist-Ulman M, Larsson U. Acute low back pain in industry, A controlled prospective study with special reference to therapy and confounding factors. Acta Orthop Scand 1977;170 Suppl:1–117.
3. Biering-Sorensen F. Physical measurements as risk indicators for low back trouble over a one-year period. Spine 1984;9:106–119.
4. Biering-Sorenson F, Thomson C. Medical, social and occupational history as risk factors for low back trouble in a general population. Spine 1986;11:170.
5. Bigos SJ, Battie MC, Spengler SM, et al. A prospective study of work perceptions and psychosocial factors affecting the report os back injury. Spine 1991;16:1–6.
6. Bodguk N. The innervation of the lumbar spine. Spine 1983;8:286–293.
7. Bodguk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat 1981;132:39–56.
8. Bodguk N, Wilson AS, Tynan W. The Human lumbar dorsal rami. J Anat 1982;134:383–397.
9. Boumphrey FRS, Bell GR, Modic M, et al. Computed tomography scanning after chymopapain injection for herniated nucleus pulposus. A prospec-tive study. Clin Orthop 1987;219:120–123.
10. Bradley KC. The anatomy of backache. Aust N Z J Surg 1974;44:227–232.
11. Breig A, Troup JDG. Biomechanical considerations in the straght-leg-raising test. Cadaveric and clini-cal studies of the effects of medial hip rotation. Spine 1979;4:242–250.
12. Bundschuh CV, Modic MT, Ross JS, et al. Epidural fibrisis and recurrent disk herniation in the lumbar spine: MR imaging assessment. AJR Am J Roentgenol 1988;150:923.
13. Dehlin O, Hedenrund B, Horal J. Back symptoms in nursing aids in a geriatic hospital. Scand J Rehabil 1976;8:47–53.
14. Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low back pain and its related medical mare in the United States. Spine 1987;12:264–268.
15. Dixon ASJ. Progress and problems in back pain research. Rheum Rehab 1973;12:165–175.
16. Dixon ASJ. Diagnosis of low back pain-sorting the complainers. In: Jayson M, editor. The Lumbar Spine and Back Pain. 9ed. New York: Grune & Stratton; 1976. pp. 77-92.
17. Fahrni WH. Observations on straight leg-raising with special reference to nerve root adhesion. Can J Surg 1966;9:44–48.
18. Fry J. In: Back pain and Soft tissue Rheumatism. Advisoty Services. Clinical and General Ltd.; 1972.
19. Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPherson B, Ashikaga T. Rick factors in low back pain. Bone Joint Surg Am 1983;65:213–218.
20. Gulliver I. Acute low back pain in industry. Acta Orthop Scand 1970;129:6.
21. Hakelius A. A prognosis in sciatica. A clinical follow-up of surgical and non-surgical treatment. Acta Orthop Scand 1970;129 Suppl:1.
22. Hwan-mo Lee.Imaging diagnosis and classification of th Lumbar disc herniation. J Korean Soc Spine Surg 2000:276–282.
23. Heliovaara MD. Body height, obesity and risk of herniated lumbar intervertebral disc degeneration. Spine 1987;12:469–472.
24. Hirsch C, Jonsson B, Lewin T. Low back symptoms in aa Swedish female population. Clin Orthop 1969;63:171–176.
25. Hirsch C, Nachemson A. The reliability of lumbar disck surgery. Clin Orthop 1963;29:189–195.
26. Hoppenfeld S. In: Orthopedic Neurology. Philadephia: Lippincott; 1977.
27. Horal J. The clinical appearance of low back disorders in the City of Gothenburg, Sweden. Acta Orthop Scand 1969;118 Suppl:8–73.
28. Hult L. Retroperitoneal disc fenestration in low back pain and sciatica: A preliminary report. Acta Orthop Scand 1951;20:342–348.
29. Hult L. Cervical, dorsal and lumbarspine syndromes. Acta Orthop Scasnd 1954;17:65–73.
30. Lassoner EM, Alho A, Karakarju EO, Paavilaimen T. Short term prognosis in sciatica. Ann Chir Gynaecol 1977;66:47.
31. MaCrae IF, Wright V. Measurement of back movement. Ann Rheum Dis 1969;28:584–589.
32. Malinsky J. The development of nerve terminations in the intervertebral discs of man. Acta Anat 1959;38:96–113.
33. Mooney V, Robertson J. The facet syndrome. Clin Orthop 1976;115:149–156.
34. Nachemson AL. The lumbar spine - an orthopedic challenge. spine 1976;1:59–71.
35. Kim Nam-Hyun,Lee Hwan-mo.In: Spinal Surgery(ed 1), 1st. medical culture; 1998. pp. 175-176.
36. ummi J. Iskiassyndroomaan leikkaushoidon indikaatiot. In: Nummi J, Jarvinen, editors. Kipuselka ja sen hoito. Helsinki: Tyoterveyslaitoksen Julkaisuja; 1974. pp. 33.
37. Ostgaard HC, Anderson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine 1972;16:549–552.
38. Pearce J, Moll J. Conservative treatment and natural history of acute lumbar disc lesions. J Neurosurg Psychiatry 1967;30:13.
39. Roland M, Morris R. A study of the natural histpry of back pain. I. Development of reliable and sensitive measure of disability in low back pain. Spine 1983;8:141–144.
40. Rothman RH. A study of computer-assisted tomo-graphy. Introduction. Spine 1984;9:548.
41. Rothman RH, Simeone FA, Bernini PM. Rothman and Simeone. In: The Spine. ed 2. vol 1. Philadelpia: Saunders; 1982. Lumbar disc disease; pp. 508-645.
42. Rydevik BL, Brown MD, Lundborg G. Pathoana-tomy and pathophysiology of nerve root compression. Spine 1984;9:7–15.
43. Sangfort E. Lasegue's sign in patients with lumbar disc herniation. Acta Orthop 1971;42:459–460.
44. Scham SM, Taylor TKF. Tension signs in lumbar disc prolapse. Clin Orthop 1971;75:195–204.
45. Spangfort EV. The lumbar disc herniation. A com-puter-acied analysis of 2, 054 operations. Acta Orthop Scand 1972;142:1–95.
46. Sugiura K, Yoshida T, Katoh S, et al. A study on tension signs in lumbar disc hernia. Int Orthop 1979;3:225–228.
47. Se-Il Suk.In: Orthopaedics. ed 5. new medical culture; 1998. pp. 451-454.
48. Se-Il Suk.In: Spinal Surgery. ed 1. new medical culture; 1997. pp. 190-202.
49. Weber H. Lumbar disc herniation. A prospective study of prognostic factors including a controlled trial. J Oslo City Hosp 1978;28:36.
50. Weber H. lumbar disc herniation: a controlled prospective study with ten years of observation. spine 1983;8:131.
51. Weinstein JN. In: The adult spine. New York: Raven Press; 1991. Anatomy and neurophysiologic mechanisms of spinal pain; pp. 593-610.
52. White AWM. Low back pain in men receiving Workmen's compensation. Can Med Assoc J 1966;95:50–56.
53. Wood PH. In: Epidemiology of back pain. The lumbar spine and back pain. Kent: Pitman Medical publishing Company; 1980. pp. 29-55.