Which Doctor Should You See for a Herniated Disc?

"I have a herniated disc — which doctor should I see?" is one of the most common questions. The right answer depends on the clinical picture; but it helps to know that the large majority of herniated discs are not an emergency and improve without surgery. The word "hernia" on an MRI doesn't on its own mean urgency or surgery.

Which departments deal with it?

• Physical Medicine and Rehabilitation (PM&R): the physician at the centre of the non-surgical path; assesses, arranges imaging and medication.
• Neurosurgery / Orthopaedics: for conditions needing surgery; for red flags or long-standing conditions unresponsive to non-surgical treatment.
• Algology: interventional methods for persistent pain.
• Physiotherapy: where non-surgical treatment is actually carried out after diagnosis.

The sensible sequence

If there's no red flag: (1) start with a PM&R or physiotherapy assessment, (2) try the non-surgical process for a few weeks — most conditions improve noticeably at this stage, (3) if there's no response, surgical assessment. So the sequence runs from non-surgical toward surgical.

Straight to the ER

Loss of bladder/bowel control, saddle-area numbness, foot drop, rapidly increasing weakness; fever or pain that doesn't ease at night.

Fzt. Kemran Hafız assesses the source of pain in a herniated disc; runs the non-surgical process with measurable goals and refers to the relevant physician when needed.

What does each department do?

Read on: The assessment process, and which findings lead to a physician referral, are on the lumbar disc herniation page.