Start by matching symptoms to the disc finding
Disc bulges and herniations are common on imaging and can exist without symptoms. The federal health portal cautions that imaging findings can be misleading when they do not match the clinical picture. A specialist review should identify whether the affected disc and nerve root actually explain the patient's pain, numbness, weakness or functional limitation.
Most uncomplicated cases begin with non-surgical treatment
For many patients, the initial plan focuses on pain relief, activity as tolerated and time for symptoms to improve. Surgery should not be chosen simply because an MRI shows a protrusion or prolapse if symptoms are improving and there is no dangerous neurological deficit.
Some neurological symptoms require urgent local assessment
Loss of bladder or bowel control, saddle-area numbness, rapidly progressive weakness or major paralysis can indicate severe nerve compression. These symptoms should not wait for elective medical travel or a routine international second opinion; urgent local assessment is appropriate.
Lumbar and cervical disc herniations are different pathways
Lumbar disc herniation commonly causes sciatica or leg symptoms, while cervical disease can cause arm pain, numbness or weakness and can involve the spinal cord in more complex cases. Freiburg documents minimally invasive or microsurgical decompression for lumbar disc herniation and separate cervical strategies that can include decompression, disc prosthesis or fusion depending on anatomy.
Microsurgical decompression is one surgical option for selected cases
Freiburg lists minimally invasive and microsurgical decompression among its operative strategies for lumbar disc herniation. UKE's spine and neurosurgery services also treat degenerative disc herniation using open and minimally invasive approaches. Ask what tissue will be removed, which nerve root is being decompressed and why that operation matches the symptoms.
Fusion should not be assumed from the word 'disc herniation'
A straightforward lumbar disc herniation may be treated without fusion when surgery is needed. Stabilization or fusion is a separate decision that can become relevant when instability, deformity, cervical anatomy, prior surgery or another structural problem changes the surgical objective. Ask the surgeon to state why any implant is needed.
Records to send before a German spine review
Provide enough information to connect the imaging with the neurological symptoms and previous treatment.
- Recent MRI images in DICOM format when requested
- Radiology report
- Description of arm or leg pain distribution
- Numbness, tingling or weakness and how these have changed
- Neurological examination findings when available
- Previous physiotherapy, injections or medication and their effect
- Previous spine operations and operative reports
- Current medication and major medical conditions
Plan recovery and return travel before surgery
If surgery is recommended, ask about expected inpatient stay, walking and activity restrictions, wound care, medication, physiotherapy, thrombosis prevention where relevant, follow-up imaging and when long-distance travel is medically reasonable.
Official sources
Sources last checked 2026-08-31. Surgical indications, hospital pathways and rehabilitation plans can change; confirm the current plan with the treating orthopedic or spine team.
- Slipped disc: causes and treatment — gesund.bund.de – German Federal Ministry of Health ↗
- University Spine Center — University Medical Center Hamburg-Eppendorf (UKE) ↗
- Neurosurgery – degenerative spinal herniation — University Medical Center Hamburg-Eppendorf (UKE) ↗
- Spine surgery – lumbar and cervical disc herniation — University Medical Center Freiburg ↗