Herniated Disc - Surgery

Surgery

Most people who have a herniated disc do not need surgery because their symptoms tend to improve over time. About 50% of people with a herniated disc in the low back recover within 1 month; after 6 months, 96% recover.¹ Only 10% of people with herniated disc problems that cause noticeable symptoms have enough pain after 6 weeks to consider surgery.²

When surgery is used to treat a herniated disc, it is done to decrease pain and allow for more normal movement and function. It is considered if the following conditions are present:⁴

• You have a history of persistent leg pain that has not gotten better with nonsurgical treatment, as well as weakness and limitation of daily activities.
• Results of a physical examination find that you currently have weakness, loss of motion, abnormal sensitivity, or a positive straight-leg test.
• Diagnostic testing, such as magnetic resonance imaging (MRI), computed tomography, or myelogram, indicates that you have a herniated disc that can be treated surgically.

Surgery is appropriate only for people who have specific symptoms and conditions. A decision to have surgery should take into consideration results from diagnostic tests and physical examinations, your response to nonsurgical treatment, and discussions between you and your health professional about your options and expected results.⁴ Other factors include your age, overall health, the severity of symptoms, and what impact the symptoms have on your life (such as the inability to work). For example, you and your health professional may consider surgery if your job requires a rapid recovery, and there is no time to wait for the herniated disc to heal itself. If you are an older adult, you may be offered surgery if your herniated disc is less likely to improve without surgery because of other spinal diseases.

Disc surgery is not considered effective treatment for low back pain that is not caused by a herniated disc. Disc surgery is also not done if back pain is the only symptom the herniated disc causes.

Surgery Choices

• Discectomy (also called open discectomy) 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 are 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, the opening in the vertebrae through which the spinal cord runs. Either procedure may be done at the same time as a discectomy, or separately.
• Percutaneous discectomy is used for bulging discs and discs that have ruptured into the spinal canal. This procedure inserts a special tool through a small incision in the back. The herniated disc tissue is then removed, thereby reducing the size of the disc herniation. Percutaneous discectomy is considered less effective than open discectomy, and its use is declining. Unless future studies show that this technique is safe and effective, percutaneous discectomy should be considered experimental.⁶

What To Think About

All surgery involves some risk. If you are considering surgery, consider the following factors:

• A number of technologies using small incisions or injections for destroying the disc are used by some surgeons. Examples are endoscopic discectomy and electrothermal disc decompression.⁷ These techniques are experimental and unproven. If your health professional recommends one of them to treat your herniated disc, make sure to get as much information as possible about the procedure. Consider a second opinion to further evaluate whether such a procedure is appropriate for you.
• People with moderate to severe symptoms may gain relief from surgery.^{8, 9} Surgery is usually not done unless symptoms are severe enough to interfere with normal activities and work, and to require strong pain medicines.
• People with milder symptoms tend to do well without surgery.
• Some people require additional disc surgery after their first surgery.

Should I have surgery for a herniated disc?

Many people are able to gradually 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.