The primary causes of a lumbar (low back) disc herniation are1Kos N, Gradisnik L, Velnar T. A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch. 2019;73(6):421-424. doi:10.5455/medarh.2019.73.421-424,2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/:

  • Degenerative changes to the disc over time, leading to progressive herniation
  • Sudden trauma to the disc from an acute injury, such as a fall 

Additionally, less common causes include certain medical conditions that affect the structural integrity of the spinal discs.

Disc Degeneration: The Most Common Cause of a Lumbar Herniated Disc

Natural degeneration of discs occurs with age and causes the spinal discs to become dehydrated and brittle. Stress and strain exerted on a disc from everyday movements also accelerate its wear and tear.1Kos N, Gradisnik L, Velnar T. A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch. 2019;73(6):421-424. doi:10.5455/medarh.2019.73.421-424,2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/

A fragile degenerated disc is susceptible to tearing and more likely to herniate under pressure, possibly even during minor movements, such as picking up a grocery bag or turning to get into a car.3Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-516. doi:10.1007/s12178-017-9441-4See Lumbar Degenerative Disc Disease Symptoms

Acute Injury and Disc Herniation

Sudden trauma that causes abrupt and forceful compression of the lower back, such as from a fall or a motor vehicle accident, has the potential to cause a herniation in a healthy or degenerated disc.2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/

In most cases, however, there is already some degree of disc degeneration, and it is rare for this type of injury to cause herniation in healthy spinal discs.2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/

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Less Common Causes of a Lumbar Herniated Disc

In rare cases, an underlying medical condition causes a disc to herniate. A few examples are discussed below.

Vertebral endplate junction failure

Between each spinal disc and vertebral body lies a structure called the vertebral endplate, which plays a role in protecting the vertebral body when the lumbar spine undergoes compressive loading.4Lotz JC, Fields AJ, Liebenberg EC. The role of the vertebral end plate in low back pain. Global Spine J. 2013;3(3):153-164. doi:10.1055/s-0033-1347298

The endplate is prone to fractures and/or detachment, which increases the risk of the soft inner core of the disc (nucleus pulposus) herniating vertically through the damaged endplate.5Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382,6Zhang AS, Xu A, Ansari K, et al. Lumbar Disc Herniation: Diagnosis and Management. Am J Med. 2023;136(7):645-651. doi:10.1016/j.amjmed.2023.03.024

Connective tissue disorders

Medical conditions associated with dysfunction or abnormalities of connective tissues have been implicated in the development of herniated discs, including7Han WJ, Kim HB, Lee GW, Choi JH, Jo WJ, Lee SM. Generalized Joint Laxity is Associated with Primary Occurrence and Treatment Outcome of Lumbar Disc Herniation. Korean J Fam Med. 2015;36(3):141-145. doi:10.4082/kjfm.2015.36.3.141:

The common feature of these conditions thought to be involved in disc herniation is laxity of the joints, which causes spinal instability.8Capsicum. Natural Medicines. Therapeutic Research Center; 2023. Updated October 11, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=945

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7 Known Risk Factors for Disc Herniation

Several biological, occupational, and lifestyle factors known to contribute to disc degeneration have been directly linked to the risk of herniation.2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/ These risk factors are described in the following table.

Risk Factor

Impact on Spinal Disc Health

1. Genetics2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/

Research suggests that genetic predisposition – the presence of specific genes or genetic variations – is one of the main risk factors for a herniated disc.

Specifically, genes involved in collagen formation, disc degeneration processes, and inflammatory response have been linked to an increased risk.

2. Age2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/,4Lotz JC, Fields AJ, Liebenberg EC. The role of the vertebral end plate in low back pain. Global Spine J. 2013;3(3):153-164. doi:10.1055/s-0033-1347298

The incidence of lumbar disc herniation increases with age and is more common in individuals aged 30 to 50 years.

3. Gender2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/,4Lotz JC, Fields AJ, Liebenberg EC. The role of the vertebral end plate in low back pain. Global Spine J. 2013;3(3):153-164. doi:10.1055/s-0033-1347298

Painful lumbar herniated discs are more common in men compared to women.

4. Weight2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/

Obesity – particularly excess body fat around the chest and abdomen – increases the load on the lower back and is thought to promote inflammation in the body, increasing the risk of developing a lumbar herniated disc.

5. Nicotine2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/ 

Nicotine use (including but not limited to smoking, vaping, and chewing tobacco) disrupts the flow of nutrients to the intervertebral discs.

Nicotine also inhibits the growth of new cells in the nucleus pulposus, and it reduces the synthesis of collagen (a type of protein).

6. Occupation2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/

Physically demanding jobs exert increased pressure on the lower back through movements such as heavy lifting, carrying heavy items, and forward bending.

Sedentary work increases the risk of disc degeneration through sustained compression loads on the spine during prolonged periods of sitting. 

Consistently working for 8 hours or longer at a time and high levels of stress have also been associated with an increased risk of disc herniation.

7. Height2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/

One study demonstrated a potential link between tall individuals and increased incidence of disc herniation.

According to the study, men 5’ 11” (180 cm) or taller and women 5’ 7” (170 cm) or taller had a higher risk for herniation.

While these factors increase the likelihood of a herniated disc, simply having these risk factors does not mean that a herniated disc will definitely develop. 

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Lowering the Risk of a Lumbar Herniated Disc

Preventing or reducing the risk of a herniated disc involves adopting lifestyle habits that promote overall spinal and disc health, including2Waxenbaum JA, Reddy V, Futterman B. Anatomy, Back, Intervertebral Discs. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470583/:

  • Maintaining a healthy weight through a balanced diet 
  • Staying well-hydrated
  • Avoiding smoking and all forms of nicotine
  • Engaging in regular exercise, including stretching, strengthening, and aerobic exercise
  • Regularly stretching, changing positions, and going for a short walk to avoid sitting for long periods
  • Using supported postures when bending, lifting, pulling, or twisting

These measures work together to protect the integrity of the spinal disc, provide support to the spine, and encourage the flow of healthy nutrients into the disc. 

Dr. Roger Härtl is a neurosurgeon with more than 20 years of experience specializing in spine surgery and neurotrauma. He is the Director of the Weill Cornell Medicine Center for Comprehensive Spine Care in New York.

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