Hérnia de disco lombar
A hérnia de disco lombar ocorre quando o núcleo do disco intervertebral se desloca através do anel fibroso e comprime uma raiz nervosa, causa frequente de ciática.
Última atualização: 2026-06-06
Definition
A lumbar disc herniation is the displacement of the gelatinous nucleus pulposus of an intervertebral disc through a tear or weakness in the surrounding annulus fibrosus. The displaced disc material may compress an exiting nerve root or, rarely, the terminal nerve bundle (cauda equina). Herniation is graded as bulging, protrusion, extrusion and sequestration according to severity.
Causes and Risk Factors
Age-related loss of disc water content (degeneration) is the underlying process. Heavy lifting, sudden twisting or bending, prolonged sitting, occupations involving vibration, obesity, smoking and genetic predisposition are recognized risk factors. In most cases repetitive mechanical loading, rather than a single injury, is responsible.
Symptoms
The hallmark is radicular pain radiating into the leg, usually unilateral (sciatica). It may be accompanied by numbness, tingling and muscle weakness. Coughing, straining or sitting can worsen the pain. Loss of bowel or bladder control, saddle anesthesia and progressive weakness suggest cauda equina syndrome and require emergency evaluation.
Diagnosis
Diagnosis rests primarily on a detailed history and neurological examination, including stretch tests such as the straight-leg-raise (Lasègue) test and assessment of dermatomal sensation, strength and reflexes. Magnetic resonance imaging (MRI) is the most sensitive modality and demonstrates the relationship between the disc and the nerve root. Correlation between clinical findings and imaging is essential, as disc protrusions are also common in asymptomatic individuals.
Treatment
Most cases improve with conservative management (short-term activity modification, analgesic and anti-inflammatory medication, physical therapy and exercise programs). Epidural steroid injections may be used for pain control in selected patients. Surgery is considered for progressive neurological deficit, cauda equina syndrome or disabling radicular pain unresponsive to adequate conservative care. Surgical options include microdiscectomy and endoscopic discectomy.
Prognosis
In most patients treated conservatively, symptoms recede substantially within weeks. Appropriately selected surgical patients can expect rapid relief of leg pain. The treatment plan is individualized for each patient by considering clinical findings together with imaging; outcomes vary from patient to patient.
Referências
- Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017.
- North American Spine Society (NASS) — Clinical Guidelines: Lumbar Disc Herniation with Radiculopathy.
- StatPearls — Lumbar Disc Herniation. NCBI Bookshelf.
Este artigo é informativo e não substitui um exame médico. As decisões de diagnóstico e tratamento são individuais.