Should I have surgery for a herniated disc?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
A herniated disc may be treated nonsurgically or with surgery. Consider the following when making your decision:
- Most herniated discs heal and pain eases after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation. Nonsurgical treatment may relieve your symptoms significantly and enable you to resume your daily activities.1
- If you have severe pain and numbness in your buttocks and legs (sciatica) that is caused by a herniated disc, surgery may give you relief.
- You may want to consider surgery if you have had severe sciatica for longer than a month.1
- If you have moderate to severe pain, you will probably experience faster relief if you have surgery. But after 5 to 10 years, the functional results (how well you can do your daily activities) are likely to be about the same whether you have surgery or not.2
Medical Information
What is a herniated disc?
The bones that form the spine in your back are cushioned by discs. Spinal discs are round and flat, with a tough, outer layer (capsule or annulus) that surrounds a jellylike material (nucleus). When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. When they are damaged from an injury, normal wear and tear, or disease, they may bulge abnormally or break open (rupture). An abnormally bulging or ruptured disc is called a herniated disc, or sometimes a slipped disc.
See an illustration of a herniated disc
.
A bulging or herniated disc may press on a nerve where the nerve branches off from the spinal cord in your back. This pressure can cause pain, numbness, tingling, weakness, or loss of reflexes in the leg. It may or may not cause lower back pain. However, many herniated discs don't cause any symptoms. If an MRI scan shows that you have a herniated disc, your doctor will carefully compare the results of the MRI with your symptoms and the results of your physical exam to be sure that the herniated disc seen on the MRI is the likely cause of your symptoms.
When is nonsurgical treatment used to treat a herniated disc?
Most herniated discs heal after a few months of nonsurgical treatment. Nonsurgical treatment may include a short period of rest, medicine for pain relief, and a physical therapy and exercise program prescribed by a health professional. About 50% of people with a herniated disc in the low back recover within 1 month; after 6 months, most recover.1 Only 10% of people with herniated disc problems have enough pain after 6 weeks to consider surgery.3
If you are getting better after 6 weeks of nonsurgical treatment, that's a good sign that your body will continue to heal without surgery. Often the body reabsorbs the material from the disc, which relieves the pain and other symptoms caused by pressure on the nerve. This process is called resorption.
When is surgery for a herniated disc recommended?
Surgery is eventually considered for about 10% of people who have a herniated disc.4 Most doctors will wait to consider surgery after you have tried nonsurgical treatment for 1 to 3 months without improvement (but usually before more than 6 months have gone by). People who have had a herniated disc that causes constant pain, weakness, or numbness for longer than 6 months may have permanent nerve damage and may benefit less from surgery.
Surgery to treat a herniated disc is done to decrease pain and allow for more normal movement and function. It is considered if the following conditions are present:5
- You have a history of persistent leg pain that has not improved with nonsurgical treatment, as well as weakness and limitation of daily activities. If you have these symptoms, take this interactive quiz
to see whether surgery might help.
- Results of a physical examination finds that you currently have weakness, loss of motion, abnormal sensitivity, or positive straight-leg test.
- Diagnostic testing, such as magnetic resonance imaging (MRI), computed tomography, or myelogram, indicates that your herniated disc can be treated surgically.
Disc surgery can be used to treat:
- A ruptured disc or free fragments of disc material that are clearly the cause of nerve root compression. If severe and disabling sciatica pain fails to improve after at least 4 to 6 weeks of nonsurgical treatment, your health professional may recommend surgery.
- A bulging or ruptured disc that is causing serious nerve damage. Common signs of nerve damage are felt in the leg, and include weakness, loss of coordination, or loss of feeling.
- A structural bone problem that can only be treated with surgery (in this case, nonsurgical treatment would be inappropriate).
- Cauda equina syndrome.
What kinds of surgery are done for a herniated disc?
The most common and well-researched herniated disc surgeries are:
- Discectomy, which is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. It is also used for bulging discs or ruptured discs. Discectomy may be the most effective type of surgery for people who have tried nonsurgical treatment without success and who have severe, disabling pain.
- Laminotomy and laminectomy, surgeries done to relieve pressure on the spinal cord and/or spinal nerve roots caused by age-related changes in the spine. Laminotomy removes a portion of the thin part of the vertebrae that forms a protective arch over the spinal cord (lamina). Laminectomy removes all of the lamina on selected vertebrae and also may remove thickened tissue that is narrowing the spinal canal
- Percutaneous discectomy, which inserts a special tool through a small incision in the back. Disc material is then removed or destroyed to try to reduce pressure on the nerve root. Percutaneous discectomy is considered less effective than open discectomy.3
What are the risks of herniated disc surgery?
Discectomy and microdiscectomy, the most common surgeries for herniated discs, are generally well-tolerated and do not commonly cause complications. However, there is a slight risk of damaging the nerve roots or spinal structures during surgery. Some people develop excessive scarring in the area of the surgery. There is also some risk of infection following surgery, which may cause further damage. An infection may require antibiotics and additional surgery.
All surgery involves some risk. Also, because there are risks with general anesthesia, your doctor and medical staff will carefully monitor you during your surgery and recovery.
How effective is herniated disc surgery?
People with milder symptoms tend to do well without surgery. People with prolonged symptoms that are severe enough to interfere with normal activities and work and that require strong pain medicines may gain relief from surgery. A study begun in 1990 followed about 500 people with low back pain caused by a herniated disc. Some had surgery and some did not. Follow-up information was gathered 5 years and 10 years after the beginning of the study.6, 2
- People with moderate to severe pain who had surgery noticed a greater improvement than those who did not have surgery.
- Those who had surgery noted more relief from the symptoms they considered most important than those who did not have surgery.
- At 5 years, 70% of those who had surgery reported improvement in their most important symptom, as compared with 56% of those who received nonsurgical treatment.
- At 10 years, 71% of people who had surgery were satisfied with their current situation, compared with 56% of those treated nonsurgically.
- But the type of treatment did not make a significant difference with regard to work and disability. The percent of people working at the time of the 10-year follow-up was similar, regardless of whether they had chosen surgical or nonsurgical treatment.
Some people elect to have surgery when work or life responsibilities make a relatively quick recovery necessary. For nonphysical work, you can expect to return to work in 2 to 4 weeks; for physically demanding work, you will require 8 to 12 weeks.
Many people are able to resume work and daily activities soon after surgery. In some cases, your health professional may recommend a rehabilitation program after surgery, which might include physical therapy and home exercises.
For more information, see the topic Herniated Disc.
Your Information
Your choices are:
- Try nonsurgical treatment, such as rest, physical therapy and exercises, and medicines.
- Have surgery.
The decision about whether to have surgery takes into account your personal feelings and the medical facts.
Making a decision about surgery for a herniated disc Reasons to have surgery Reasons not to have surgery
- You have severe and disabling leg pain, numbness, or weakness.
- Your leg symptoms do not get better with at least 4 weeks of nonsurgical treatment.
- You have signs that pressure on a nerve is getting worse (increased pain in your leg, significant loss of feeling, paralysis or increasing weakness, loss of coordination, complete loss of reflexes).
- You have work demands that require you to recover function relatively quickly.
- You are able to stick with a rehabilitation regimen for a number of weeks following surgery.
Are there other reasons you might want to have herniated disc surgery?
- You want to use nonsurgical methods, including physical therapy, exercise, rest, and medicines, to heal your herniated disc.
- There is no guarantee that surgery will relieve your symptoms.
- There is no guarantee that surgery will be more beneficial than nonsurgical treatment over the long term.
- Surgery poses the risk of infection, pain, slow healing, and a potential need for more surgery. All surgeries pose some risk of complications such as heart attack.
- There is no guarantee that you won't need a repeat surgery.
Are there other reasons you might not want to have herniated disc surgery?
These personal stories may help you make your decision about herniated disc surgery.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about herniated disc surgery. Discuss the worksheet with your health professional.
Circle the answer that best applies to you.
I am disabled by a herniated disc. Yes No Unsure My doctor has me doing exercises at home, and I think it's helping my back. Yes No NA* I have moderate to severe leg pain that has been making daily life difficult for at least a month. Yes No Unsure I'm concerned that I'll need repeat surgery in a few years. Yes No Unsure I've been doing the exercises prescribed by my physical therapist for 8 weeks, but I'm still in a lot of pain. Yes No NA I am comfortable with the idea of having back surgery. Yes No Unsure I'm taking medicines, and they seem to be helping. Yes No NA I have a herniated disc that has caused pain, weakness, and numbness for longer than 6 months. Yes No NA *NA = Not applicable
Use the space below to list any other important concerns you have about this decision. Include all questions that you have for your doctor.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have herniated disc surgery.
Check the box below that best represents your overall impression about your decision.
Leaning toward having herniated disc surgery
Leaning toward NOT having herniated disc surgery
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| Author: | Shannon Erstad, MBA/MPH | Last Updated: August 9, 2006 |
| Medical Review: | William M. Green, MD - Emergency Medicine Robert B. Keller, MD - Orthopedics | |
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