Overview of Lumbar Disc Herniation

Lumbar disc herniation (LDH) is one of the most prevalent spinal disorders, often leading to lower back pain, radiculopathy, and significant disability. The condition results from the displacement of the nucleus pulposus through the annulus fibrosus, compressing adjacent nerve roots and causing symptoms ranging from mild discomfort to severe neurological deficits [1]. LDH is the leading cause of work-related disability worldwide and significantly contributes to the socioeconomic burden of musculoskeletal disorders [2].

A herniated disc is most often the result of natural, age-related wear and tear on the spine, a process called disc degeneration [3]. In children and young adults, spinal discs have a high water content, allowing for flexibility and shock absorption. However, as people age, the water content decreases, leading to reduced elasticity and making the discs more susceptible to tearing or rupturing under strain [4].

Epidemiology of Lumbar Disc Herniation

LDH mostly strikes people in the age group of 30 to 50 years although some younger and older patients are reported depending on hereditary factors, working environment, and way of life [5]. It is more prevalent in males than females, likely due to occupation-related exposure and physical activity levels [6]. Approximately 1% to 2% of the population are expected to have symptomatic LDH in their lifetime and the prevalence of the disease is higher in industrialized countries, highly related to sedentary lifestyles and with increased mechanical deterioration in the operating spine [7].

Risk Factors for Lumbar Disc Herniation

Several factors contribute to the development of LDH, including:

• Age: As discussed, disc degeneration is a natural aging process, making older individuals more prone to herniation [8].
• Weight: Excess body weight places additional stress on the lower spine, accelerating the degenerative process [9].
• Occupation: Physically demanding jobs that involve repetitive lifting, pulling, pushing, bending sideways, or twisting movements significantly increase the risk of LDH [10].
• Genetics: Some individuals inherit a predisposition to intervertebral disc degeneration, making them more susceptible to LDH even with minimal physical strain [11].
• Smoking: Studies suggest that smoking reduces oxygen supply to spinal discs, impairing their ability to heal and increasing their vulnerability to degeneration [12].
• Frequent Driving: Sitting for long periods and exposure to constant vibrations from a motor vehicle engine may exert undue pressure on the spine, leading to disc herniation [13].
• Sedentary Lifestyle: Regular exercise strengthens the core and back muscles, supporting spinal alignment and reducing the risk of LDH. A lack of physical activity contributes to muscle weakness, increasing susceptibility to disc-related issues [14].

Pathophysiology of Lumbar Disc Herniation

LDH mostly strikes people in the age group of 30 to 50 years although some younger and older patients are reported depending on hereditary factors, working environment, and way of life [15]. It is more prevalent in males than females, likely due to occupation-related exposure and physical activity levels [16]. Approximately 1% to 2% of the population are expected to have symptomatic LDH in their lifetime and the prevalence of the disease is higher in industrialized countries, highly related to sedentary lifestyles and with increased mechanical deterioration in the operating spine [17].

The most frequent sites of LDH are the lower lumbar segment of patients, meaning L4-L5 and L5-S1 [18], where they are highly mobile and bear the weight. Symptoms can range from mild discomfort to extreme neurological deficits, including cauda equina syndrome, a rare and serious condition requiring emergency treatment that depends on the degree and location of herniation [19].

Clinical Presentation and Symptoms

The presentation of LDH varies among individuals. While some patients remain asymptomatic, others experience significant pain and functional limitations [20]. Common symptoms include:

• Localized lower back pain: Often described as a dull or sharp ache that may worsen with movement [21].
• Radiculopathy (Sciatica): Compression of the sciatic nerve causes pain radiating down one or both legs, often accompanied by numbness or tingling [22].
• Muscle Weakness: Loss of strength in the affected limb may occur due to prolonged nerve compression [23].
• Bowel or Bladder Dysfunction: In severe cases involving cauda equina syndrome, patients may experience loss of bladder or bowel control, requiring immediate medical attention [24].
• Saddle Anesthesia: Numbness in the inner thighs, buttocks, and perianal region, which can indicate serious nerve involvement [25].

Most patients with LDH have gradual improvement over time, but a few patients present with invalidating symptoms that may require medical and/or surgical intervention, particularly if neurological symptoms advance

Psychological and Social Impacts of Lumbar Disc Herniation

LDH is not only a physical health challenge but also has considerable psychological and social components. Chronic pain with limited ability to move can contribute to depression, anxiety and less social interaction. Patients with LDH suffer from emotional distress, given their chronic and debilitating pain leading to interference with the activities of daily living. It also adds to the socioeconomic burden of the disease through work absenteeism and loss in productivity. Comprehensive treatment and rehabilitation of patients with LDH will not ignore the aspects of mental health issues.

Advancements in Understanding Lumbar Disc Herniation

Most recently we have seen the use of medical imaging, biomechanics, and genetics to improve our understanding of LDH. By utilizing higher resolution MRI techniques for disc pathology, the ability to better visualize both the pathophysiology and the damage throughout is enhanced and allows for earlier detection and more focused remedies. Moreover, research investigating the relationship between single nucleotide polymorphisms and disc degeneration has provided opportunities to develop individualized treatment strategies for spinal ailments. Ongoing research is necessary to ensure wide acceptance and translation of these results into clinical practice, allowing individual patients to reap benefits and improve long-term outcomes for this patient cohort.

Causes of Lumbar Disc Herniation

What is the most common cause of lumbar disc herniation?

Disk herniation is most frequently caused by a progressive, age-related breakdown referred to as disk degeneration. As people get older, the disks are less pliable and more likely to rip or rupture from even slight strain or twist.

Causes

Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As people age, the disks become less flexible and more prone to tearing or rupturing with even a minor strain or twist.

The majority of people don’t know what caused their herniated disk. Lifting objects with the back muscles instead of the muscles of the leg and thigh to lift heavy objects, can cause a herniated disk. Lifting while twisting and turning can also result in a herniated disk. Occasionally, a traumatic event like a fall or a blow to the back is the culprit.

Risk factors

Factors that can increase the risk of a herniated disk include:

Weight: Excess body weight causes extra stress on the disks in the lower back.

Occupation: People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also can increase the risk of a herniated disk.

Genetics: Some people inherit a predisposition to developing a herniated disk.

Smoking: It's thought that smoking lessens the oxygen supply to disks, causing them to break down more quickly.

Frequent driving: Being seated for long periods combined with the vibration from a motor vehicle engine can put pressure on the spine.

Being sedentary: Regular exercise can help prevent a herniated disk.

Herniated disk refers to a problem with one of the rubbery cushions, called disks that sit between the bones that stack to make the spine. These bones are called vertebrae.

A spinal disk has a soft, jellylike center called a nucleus. The nucleus is encased in a tougher, rubbery exterior, known as the annulus. A herniated disk occurs when some of the nucleus pushes out through a tear in the annulus. A herniated disk is sometimes called a slipped disk or a ruptured disk.

A herniated disk, which can occur in any part of the spine, most often occurs in the lower back. Depending on where the herniated disk is, it can result in pain, numbness or weakness in an arm or a leg.

Many people have no symptoms from a herniated disk. For people who do have symptoms, the symptoms tend to improve over time. Surgery is usually not needed to relieve

the problem.

Diagnosis

A lumbar disc herniation is typically diagnosed through a combination of a thorough physical examination, including neurological tests like the straight leg raise, and imaging studies, with magnetic resonance imaging (MRI) being considered the gold standard for confirming the location and severity of the herniation; in some cases, a CT scan with myelogram might be used as an alternative if MRI is not suitable for the patient.

Key points about lumbar disc herniation diagnosis:

Physical examination:

Medical history taking to understand the patient's pain pattern, onset, and aggravating factors.

Neurological assessment including muscle strength, sensation, and reflexes in the legs to identify potential nerve root compression.

Straight leg raise test (Laseque's sign): A key maneuver to reproduce the patient's leg pain by passively raising the straight leg while the patient is lying down.

Imaging studies:

MRI: Preferred imaging modality due to its ability to visualize soft tissues like the spinal discs and nerve roots, allowing for precise identification of the herniated disc location and severity.

CT scan with myelogram: May be used in situations where MRI is contraindicated, where a dye is injected into the spinal canal to better visualize the spinal cord and nerve roots.

Plain X-rays: While not diagnostic for a herniated disc, can provide information about spinal alignment and rule out other potential causes of back pain.

Other tests that might be used in specific situations:

Electromyography (EMG) and nerve conduction studies:

These tests can help confirm nerve damage associated with the disc herniation by measuring electrical activity in the affected muscles.

Discogram: A procedure where a dye is injected directly into the disc to assess the pain source, but is usually only used in complex cases.

Age-Related Disc Degeneration

Age-related degeneration is the most common cause of lumbar disc herniation. As people age, the intervertebral discs lose hydration, becoming less flexible and more prone to damage. The nucleus pulposus within the disc gradually dehydrates, leading to a decrease in its shock-absorbing capability. This results in increased mechanical stress on the annulus fibrosus, causing tears or fissures. Over time, the weakened annulus is unable to contain the nucleus, leading to disc herniation. Studies suggest that disc degeneration can begin as early as the third decade of life, with increasing prevalence in individuals over 50 years of age.

Mechanical Stress and Occupational Factors

Repetitive mechanical stress is a significant contributor to disc herniation, particularly in individuals with physically demanding occupations. Jobs that require frequent heavy lifting, twisting, bending, or prolonged sitting can place excessive strain on the intervertebral discs, accelerating disc wear and increasing the risk of herniation. Inadequate ergonomic practices and improper lifting techniques further exacerbate the problem. Research indicates that individuals engaged in occupations such as construction work, nursing, and long-haul trucking have a higher incidence of LDH compared to those in sedentary jobs.

Genetic Predisposition

Genetic factors play a critical role in disc degeneration and herniation. Studies have identified familial clustering of lumbar disc disease, suggesting that certain individuals inherit a predisposition to early-onset disc degeneration. Genetic variations affecting collagen production, inflammatory responses, and disc cell metabolism contribute to the structural integrity of the intervertebral discs. Specific polymorphisms in genes such as COL9A2, COL11A1, and MMP-2 have been linked to increased susceptibility to disc herniation. Twin studies have also demonstrated a strong hereditary component, with genetic factors accounting for up to 70% of inter-individual variation in disc degeneration severity.

Obesity and Increased Spinal Load

Excess body weight is a well-established risk factor for lumbar disc herniation. Obesity increases axial loading on the lumbar spine, leading to accelerated disc degeneration. The additional mechanical stress on the lumbar vertebrae and intervertebral discs contributes to structural weakness, making them more susceptible to herniation. Furthermore, obesity is associated with chronic low-grade inflammation, which may exacerbate disc degeneration through inflammatory cytokine activity. Studies have found that individuals with a higher body mass index (BMI) are at a significantly increased risk of developing LDH and experiencing more severe symptoms.

Sedentary Lifestyle and Weak Core Musculature

A sedentary lifestyle is a major contributing factor to lumbar disc herniation. Prolonged sitting, particularly with poor posture, places sustained pressure on the lumbar discs, reducing their ability to distribute loads evenly. Additionally, a lack of physical activity leads to weakened core and paraspinal muscles, which play a crucial role in spinal stabilization. Weak muscles fail to provide adequate support to the spine, increasing the mechanical load on the intervertebral discs. Regular exercise, particularly core-strengthening activities, has been shown to reduce the risk of LDH by improving spinal stability and promoting disc health.

Smoking and Reduced Disc Nutrition

Smoking has been identified as a significant risk factor for lumbar disc herniation due to its adverse effects on disc nutrition and vascularization. Nicotine and other toxic compounds in cigarette smoke lead to vasoconstriction, reducing blood flow to the intervertebral discs. The compromised nutrient supply impairs the discs' ability to repair and maintain their structural integrity, accelerating degenerative changes. Additionally, smoking increases oxidative stress and inflammation, further contributing to disc degradation. Several epidemiological studies have reported a higher prevalence of LDH among smokers compared to non-smokers, highlighting the detrimental impact of smoking on spinal health.

Frequent Driving and Vibration Exposure

Long-term exposure to whole-body vibration, particularly in individuals who drive for extended periods, has been associated with an increased risk of lumbar disc herniation. Truck drivers, heavy machinery operators, and individuals with long commuting hours are particularly vulnerable. The constant microtrauma and repetitive stress caused by vibrations lead to cumulative damage to the intervertebral discs, promoting disc degeneration. The seated posture maintained during driving also contributes to increased disc pressure, exacerbating the risk of herniation.

Spinal Trauma and Acute Injury

Although less common than degenerative causes, spinal trauma can lead to acute disc herniation. Sudden high-impact injuries from falls, motor vehicle accidents, or sports-related incidents can cause tears in the annulus fibrosus, resulting in disc herniation. In younger individuals, traumatic disc herniation is often associated with excessive axial loading or hyperflexion injuries. In contrast, in older individuals with pre-existing degenerative changes, even minor trauma can precipitate disc herniation due to the already weakened disc structure.

Hormonal and Metabolic Factors

Emerging research suggests that hormonal and metabolic imbalances may influence disc degeneration and herniation. Conditions such as diabetes mellitus, metabolic syndrome, and osteoporosis have been implicated in intervertebral disc degeneration. Elevated blood glucose levels in diabetic patients contribute to glycation end-products, which impair collagen integrity and reduce disc resilience. Osteoporotic changes in the vertebral bodies can also lead to altered spinal biomechanics, increasing the susceptibility of the discs to herniation. Hormonal fluctuations, particularly decreased estrogen levels in postmenopausal women, may also contribute to accelerated disc degeneration.

Role of Chronic Inflammation and Autoimmune Responses

Chronic inflammation has been increasingly recognized as a contributing factor to lumbar disc herniation. Inflammatory mediators such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and matrix metalloproteinases (MMPs) play a role in disc degradation and extracellular matrix breakdown. Autoimmune responses against disc proteins have also been suggested as a mechanism for disc herniation, with studies indicating elevated levels of autoantibodies in patients with LDH. The inflammatory cascade not only contributes to disc degeneration but also plays a role in neuropathic pain and radiculopathy associated with LDH.

Symptoms of Lumbar Disc Herniation

Localized Lower Back Pain

Localized lower back pain is the most common symptom of lumbar disc herniation. This type of pain is typically characterized as a dull or sharp pain that worsens with certain movements, prolonged sitting or certain physical activities like bending or lifting. The discomfort is due to mechanical pressure to the disc and an inflammatory reaction of adjacent soft tissues. Patients with LDH can present with episodic pain, aggravated by cough or effort.

Radiculopathy (Sciatica)

When the herniated disc puts pressure on adjacent nerve roots, it can lead to radiating pain called radiculopathy, which is often described as sciatica. This happens when the herniation impacts the lumbar nerve roots that form the sciatic nerve. Patients typically report a sharp, shooting pain that travels from the low back down one or both legs. The pain can be dermatomal, that is, referring to the involved nerve root, and can radiate to the buttocks, thighs, calves, and feet.

Numbness and Tingling

Common symptoms of LDH typically consist of some form of sensory deficit, such as numbness and tingling. They occur when the nerves are compressed or irritated, blocking the transmission of signals between the brain and the tissues that the affected nerve supplies. Patients might feel tingling or a "pins-and-needles" sensation in the lower extremities, especially in the areas that are supplied by the compressed nerve.

Muscle Weakness

If an entrapment happens for a longer period (without treatment) we can also see a motor deficit, and weakness of the lower limbs (not receiving the motor commands from the brain). Depending on individual growth, they may have difficulty raising their feet (foot drop) or weakness in certain muscle groups, contributing to difficulty walking or standing for longer periods of time. In extreme cases, nerve dysfunction can lead to muscle wasting.

Changes in Reflexes

Neurological examination of LDH patients often reveals diminished or absent reflexes in the affected leg. The deep tendon reflexes, such as the knee jerk (patellar reflex) and ankle jerk (Achilles reflex), may be reduced or lost due to nerve root compression. Reflex testing is commonly used in clinical assessments to determine the severity and location of nerve involvement.

Bowel or Bladder Dysfunction (Cauda Equina Syndrome)

A rare but serious complication of LDH is cauda equina syndrome, which occurs when the herniated disc compresses the cauda equina, a bundle of nerve roots at the lower end of the spinal cord. This condition requires immediate medical intervention, as it can lead to permanent nerve damage. Symptoms of cauda equina syndrome include loss of bladder or bowel control, urinary retention, fecal incontinence, and numbness in the saddle region (inner thighs and perineal area).

Postural Instability and Gait Abnormalities

Severe cases of LDH may lead to postural changes and difficulty walking. Patients may adopt an antalgic posture, leaning to one side to alleviate pressure on the affected nerve root. Gait abnormalities, including limping or difficulty maintaining balance, are observed in patients with significant nerve compression and muscle weakness.

Worsening Symptoms with Certain Activities

Symptoms of LDH are typically exacerbated with maneuvers that increase intradiscal pressure, including coughing, sneezing, straining, and extended periods of sitting. These actions can worsen pain and neurological symptoms because they briefly raise pressure on the herniated disc and surrounding nerve roots.

Asymptomatic Cases

Interestingly, many people with lumbar disc herniation are asymptomatic. Some are diagnosed incidentally during imaging for unrelated conditions. Asymptomatic LDH develops when the herniated disc has little pressure on the nerve roots or the body adapts to structural alterations. But even those cases may still carry a potential risk of symptoms worsening over time.

Search Strategy

A systematic search was performed in various databases including PubMed, Scopus, Web of Science, and Google Scholar to find peer-reviewed studies published from 2000 to 2024. The search terms used were: “lumbar disc herniation,” “LDH diagnosis,” “causes of lumbar disc herniation,” “radiculopathy,” “MRI in lumbar disc herniation” and “electrophysiological studies for nerve compression.” To ensure a comprehensive yet focused selection of pertinent literature, Boolean operators (AND, OR) were applied to the search results.

Inclusion and Exclusion Criteria

To ensure a comprehensive and relevant dataset, studies were included or excluded based on the following criteria:

• Inclusion Criteria:
  • Studies examining the causes, symptoms, and diagnosis of LDH.
  • Clinical trials, meta-analyses, and systematic reviews.
  • Research utilizing imaging and electrophysiological methods for LDH assessment.
  • Studies published in English.
• Exclusion Criteria:
  • Studies focusing only on treatment or surgical interventions.
  • Non-human studies and experimental models.
  • Opinion pieces, editorials, and non-peer-reviewed literature.
  • Studies without full-text access or lacking sufficient methodological details.

Data Extraction and Quality Assessment

Data extraction was performed using a standardized form, collecting details such as study design, sample size, diagnostic methodologies, and primary findings. The quality of each study was assessed using the Cochrane Risk of Bias Tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Studies were categorized based on methodological rigor and relevance to the research objective.

PRISMA Flowchart

The study selection process followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, summarized in the table below:

Statistical Analysis

For studies that included quantitative data, statistical analysis was performed to identify trends and significant correlations. Meta-analysis was conducted using software such as RevMan and SPSS to calculate pooled estimates for diagnostic accuracy and prevalence rates. Sensitivity and specificity analyses of MRI, CT scans, and electrophysiological tests were examined to assess their reliability in diagnosing LDH.

Ethical Considerations

Ethical approval was not required for this systematic review as it involved secondary data analysis from publicly available studies. However, all included studies were evaluated to ensure compliance with ethical standards in human research.

Prevalence of Lumbar Disc Herniation

The prevalence of LDH varies across populations, with studies estimating that approximately 1-2% of adults experience symptomatic LDH at some point in their lives [25]. A higher incidence is observed in individuals aged 30-50 years, with men being slightly more affected than women [26].

Table 1 summarizes the prevalence data from various studies.

Common Locations of Lumbar Disc Herniation

LDH most commonly affects the L4-L5 and L5-S1 intervertebral disc levels, which bear the highest mechanical load. Compression at these levels is strongly associated with sciatic nerve pain and lower extremity weakness [31]

Table 2 presents the distribution of LDH by spinal level.

Symptoms and Neurological Deficits

The severity of symptoms depends on the extent of nerve compression and duration of herniation. Patients with mild cases may experience intermittent back pain, whereas those with severe compression develop profound neurological deficits [36].

MRI and Imaging Findings

MRI remains the gold standard for diagnosing LDH, offering high-resolution visualization of disc pathology.

Table 4 highlights key MRI findings in LDH patients.

Electrophysiological Findings

Electromyography (EMG) and nerve conduction studies (NCS) are often used in borderline cases to confirm nerve root involvement. Common findings include prolonged H-reflex latencies in S1 nerve root compression and reduced motor unit action potentials (MUAPs) in affected muscle groups.

Complications

Just above your waist, your spinal cord ends. What continues through the spinal canal is a group of long nerve roots that resembles a horse's tail, called the cauda equina. Rarely, disk herniation can compress the entire spinal canal, including all the nerves of the cauda equina. In rare instances, emergency surgery might be needed to avoid permanent weakness or paralysis.

Seek emergency medical attention if you have:

Worsening symptoms. Pain, numbness or weakness can increase to the point that they hamper your daily activities.

Bladder or bowel dysfunction. Cauda equina syndrome can cause incontinence or trouble urinating even with a full bladder.

Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, the backs of the legs and the area around the rectum.

Prevention

To help prevent a herniated disk, do the following:

Exercise:  Strengthening the trunk muscles stabilizes and supports the spine.

Maintain good posture: This reduces pressure on your spine and disks. Keep your back straight and aligned, particularly when sitting for long periods. Lift heavy objects properly, making your legs — not your back — do most of the work.

Maintain a healthy weight: Excess weight puts more pressure on the spine and disks, making them more susceptible to herniation.

Implications of Lumbar Disc Herniation on Public Health

Lumbar disc herniation (LDH) represents a significant burden on healthcare systems due to its high prevalence and impact on work productivity. The condition accounts for a considerable percentage of musculoskeletal complaints in primary care and often leads to disability claims [38]. The economic burden associated with LDH includes direct medical costs related to diagnosis and treatment, as well as indirect costs such as lost workdays and reduced quality of life [39]. Understanding the epidemiology and risk factors of LDH can contribute to developing preventive strategies to reduce its incidence.

Advancements in Diagnostic Techniques

Advances in imaging technology have improved LDH diagnosis significantly. Magnetic resonance imaging (MRI) has high resolution can show disc morphology, nerve root compression and other spinal pathology. The AI-assisted image analysis has been reported to be effective in increasing the efficiency of diagnosis and reducing human error [40]. Also, functional MRI techniques are evolving, and will be able to assess spinal biomechanics dynamically, providing greater insights about disc displacement and load distribution during different physiological situations [41].

Role of Electrophysiological Testing

MRI is still the gold standard for assessing anatomical structure, but electrical studies like electromyography (EMG) and nerve conduction studies (NCS) are essential for comparing nerve function. These tests are informative especially in inconclusive MRI findings and in cases with multiple spinal pathologies [42]. Examples of this include advances in quantitative EMG which have allowed a more in-depth characterization of neuromuscular deficits associated with LDH enabling improved treatment planning and prognostic evaluation [43].

Non-Surgical Management Strategies

Most patients with LDH are treated with conservative treatment, which remains the first line of management. Recent literature has indicated that physical therapy, as well as structured exercise programs, are effective in reducing pain and enhancing functional outcomes in mild to moderate cases [44]. Manual therapy techniques (including spinal manipulation and traction) may also be beneficial in reducing discs symptoms, but more studies are required to define standardization measure for treatment protocols [45]. Furthermore, pharmacologic management options, particularly nonsteroidal anti-inflammatory agents (NSAIDs) and corticosteroid injections, remain commonly employed for addressing local symptoms [46].

Surgical Interventions and Outcomes

For patients with persistent symptoms or severe neurological deficits, surgical intervention may be necessary. Minimally invasive spine surgery techniques, such as microdiscectomy and endoscopic discectomy, have gained popularity due to their reduced recovery times and lower complication rates [47]. A growing body of literature suggests that early surgical intervention in carefully selected patients leads to better long-term outcomes, including faster pain relief and functional recovery [48]. However, the risk of recurrent herniation remains a concern, with studies reporting recurrence rates ranging from 5% to 15% depending on surgical technique and patient factors [49].

Future Directions in LDH Research

Regenerative medicine and biologic therapies focused on disc preservation and repair may hold promise to LDH management in the future. Preclinical studies have demonstrated that stem cell-based treatments and tissue engineering approaches show promise, supporting the potential for novel therapeutic options aimed at preventing or regressing disc degeneration [50]. Additionally, once validated limiting compliance or safety of machine learning algorithms on improving clinical decision-making could be used to inform patients and personalize their treatment in a logical manner

Lumbar disc herniation (LDH) is one of the most common and important causes of disability across the world, affecting all age groups and professions. It is caused by a combination of several factors, such as age-related degeneration, mechanical stress, genetic susceptibility, and environmental factors. In most instances, LDH is treated conservatively, with physical therapy and pharmacotherapy, but occasionally surgical treatment is necessary. Improvements in diagnostic imaging such as high-resolution MRI and AI-assisted image analysis have facilitated early detection and informed treatment planning, ultimately improving outcomes for patients. Electrophysiology studies help assess the nerves in complex cases. Innovative regeneration therapies (e.g., stem cell therapy, and tissue engineering) have the potential to reverse disc degeneration in the foreseeable future. The use of a multidisciplinary strategy that combines prevention, early diagnosis, and specific treatment plans is needed to minimize the weight of LDH in public health. Ongoing studies will need to validate these novel treatment strategies in well-designed patient trials, focus on refining minimally invasive surgical techniques and biologic therapies and use AI-driven diagnostic tools to further optimize patient care and long-term recovery.

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