I think I have back and leg pain from a disc problem. But I can’t seem to get a clear ‘yes’ or ‘no’ (do I or don’t I have a herniated disc) from my doctor. Is it really so tough to figure out? Maybe I should see someone else. What do you think?

Accurate diagnosis of disc herniation can definitely be a complex and challenging process. There is no cookie cutter approach that is reliable. This is because the pathomechanics and pathophysiology of nerve root irritation causing leg pain, numbness, and/or weakness (referred to as radiculopathy) is complex.

For example, two patients can have the same type of disc herniation with pressure on the spinal nerve root from the bulging disc and still have very different symptoms. In fact, the pain patterns and symptom presentation for lumbar disc herniation is often quite variable.

There are several separate components of the problem that must be determined: is there a disc herniation and if so, what level? Is the disc compressing or chemically irritating one (or more) spinal levels? And again, if so, what level(s)?

Currently, there are no neurologic clinical tests that have been shown to conclusively diagnose disc herniation based on the presence of radiculopathy (symptoms from compression on a spinal nerve root). Future studies are needed to find and standardize clinical tests that are valid and reliable in accurately diagnosing nerve root irritation (radiculopathy) associated with disc herniation.

For now, the physician must rely on patient history (what you tell him/her happened and what are your symptoms) along with the results of clinical tests, electrodiagnostic tests, and imaging studies. Even when electrodiagnostic tests are done to confirm nerve involvement, severe disc herniation can be present with no signs of weakness or sensory changes. Sometimes even with all that information, it’s still not entirely clear what the problem is.

Patients who have surgery don’t always obtain relief from their symptoms so the decision to recommend surgery is not made easily or lightly. Conservative care is almost always advised. The physician follows the patient to see what kind of response occurs with nonoperative care. Even this information is diagnostic in nature.

It is possible that you might find another physician who would be more assertive and certain about your diagnosis. And there is nothing wrong with seeking out a second (or even third) opinion (especially if you are facing the possibility of spinal surgery). But give yourself some time to let nature take its intended course (healing) while you pursue a course of recommended self-care via the conservative approach.