Objective To compare the clinical value between multi-slice spiral CT (MSCT) and magnetic resonance imaging (MRI) in the diagnosis of lumbar disc herniation (LDH). Methods The clinical data of 200 patients with LDH who treated during the period from May 2016 to May 2017 were analyzed retrospectively. All patients were diagnosed by MSCT and MRI, and confirmed by surgery and pathology. With pathological diagnosis as the standard, the positive rates of LDH diagnosed by MSCT and MRI were compared. The diagnosis of LDH signs by MSCT and MRI were also compared, including calcification, intervertebral disc pneumatosis, intervertebral disc deformation, dural sac compression, spinal cord deformation and nerve root compression. Results There was no statistically significant difference in the coincidence rate in diagnosis of LDH between MSCT and MRI [89.00% (178/200 vs 91.00% (182/200)] (P>0.05). The positive rates of calcification and intervertebral disc pneumatosis diagnosed by MSCT were significantly higher than those by MRI while positive rates of intervertebral disc deformation, dural sac compression and spinal cord deformation were significantly lower than those by MRI (P<0.05). Conclusion In the clinical diagnosis of LDH, both MSCT and MRI can achieve good diagnostic efficiencies, and both of them have their own advantages. The effect of MRI is better in displaying the internal structure of spinal canal. The combination of the two methods can improve the accuracy of diagnosis.