How bad does a herniated disc have to be for surgery?
Most cases of herniated discs resolve with conservative therapy and do not require surgery.

Most herniated discs respond positively to conservative therapy, but it is critical to proceed with care when considering surgery. However, in the case of disc herniations that cause functional difficulties (such as loss of muscular strength and bowel or bladder control), the extruded disc material could be removed as soon as possible to avoid irreparable nerve damage.

Fortunately, there are several treatment options for disc herniations, including pain medication, physical therapy, and steroid injections. Surgical techniques can help reduce herniated disc discomfort and potentially prevent additional damage.

Although surgery gives faster pain relief than most other therapies, it is not necessarily the best option for most people. If you cannot decide between therapies, talk to your doctor about your best alternatives.

Am I a candidate for herniated disc surgery?

Most people's herniated disc symptoms resolve with conservative therapy or without treatment at all. Many people who suffer from disc herniations can manage their symptoms with conservative measures, such as medicines, physical therapy, or steroid injections. When these therapies fail, your doctor may advise you to have surgery to reduce your pain and avoid additional harm.

If you are not sure if your issue requires surgery, here are five variables that assist doctors in deciding on appropriate treatment.

  1. Persistent discomfort that did not respond to conservative care even after four to eight weeks
  2. Lower limb weakness influencing mobility, whether standing or walking
  3. Daily tasks are becoming difficult due to severe discomfort
  4. Extreme numbness or tingling in the upper or lower limbs
  5. Inability to control bladder or bowel movements

Depending on the extent of your disability and the intensity of your pain, your doctor may recommend surgery. If you are experiencing any of the listed symptoms, surgical treatment is strongly advised. In severe cases of disc herniations, surgical procedures may be the only option if your symptoms are causing unbearable pain or problems with bladder or bowel functions.

What are the non-surgical treatment options for a herniated disc?

A herniated disc may appear to be a severe condition, but there are several treatment options available. Disc herniation usually improves over a few days to weeks. In the early stages, the patient may respond well to conservative treatment and may not require surgery.

If you do not have severe symptoms of nerve compression or disability, conservative treatment is usually the first choice. The goal of non-surgical or conservative treatment is to alleviate your symptoms.

2 types of nonsurgical treatment for herniated disc

  1. Medication
    • For mild to severe pain, anti-inflammatory drugs, such as ibuprofen and naproxen, are routinely recommended.
    • These over-the-counter drugs can help you reduce inflammation and relieve discomfort.
    • For patients who have severe pain or chronic pain for more than six weeks, your doctor may consider steroid injections, such as cortisone.
  2. Physical therapy
    • Following a physical examination, your physical therapist develops a rehabilitation plan tailored to the treatment of herniated discs.
    • The treatment's purpose is to help you rebuild muscle strength and avoid reinjury.
    • Therapy may include exercises to improve the muscles in your lower back, legs, and abdomen.
    • You may need to learn good posture, walking, and lifting practices. Finally, stretching exercises might help you enhance your spine and leg flexibility.
    • Rest frequently and avoid strenuous activity in your everyday tasks. Nonsurgical herniated disc treatment may take four to eight weeks to achieve pain-free and full activity.

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What are the surgical treatment options for a herniated disc?

If pain medication and nonsurgical therapy have not relieved your chronic discomfort, your doctor may recommend invasive surgical surgery for your herniated disc. Too much strain on your nerve roots may cause discomfort. Disc surgery may be performed by an orthopedic surgeon or a neurosurgeon to alleviate the pressure or compression of an intervertebral disc on a nerve root.

6 surgical treatment options

  1. Open diskectomy
    • Your surgeon will make an incision in the midline of your lower back to remove the herniated disc during an open discectomy.
    • Your surgeon may remove any bone spurs and bony protrusions that may cause joint injury, during this open back surgery.
    • Open discectomy has a high success rate and is highly recommended for treating lumbar disc herniation patients.
  2. Microdiscectomy or endoscopic spine surgery
    • It is essentially a less invasive variant of open discectomy. To remove the herniated disc, a 1.5-inch or smaller incision is required.
    • An endoscope is a long, thin tube that enables improved viewing of your nerve roots and surrounding tissues.
    • Microdiscectomy is frequently the preferred surgery because it causes less tissue injury, blood loss, and noticeable scars and has low infection risks.
  3. Spinal disc core surgery
    • Your surgeon will treat the herniation from the core of the intervertebral disc during spinal disc core surgery.
    • They create an incision in your back to reach the damaged disc and use suction to remove the disc's core.
    • It causes your intervertebral disc to shrink, relieving strain on your nerves.
    • Disc core surgery is only advised if your disc's outer layer has not yet been injured.
  4. Laminectomy
    • Laminectomy is a popular surgical procedure performed to treat disc herniation, especially in the back and neck.
    • A laminectomy involves making a surgical incision in the midline of your back to remove the entire or a portion of the vertebra (spine bone) called the lamina.
    • It relieves pressure on your nerve roots and spinal cord, allowing them to relax.
    • Following the removal of the lamina, your surgeon will be able to conduct a diskectomy to remove the herniated disc.
    • Laminectomy relieves leg discomfort and other symptoms associated with disc herniation.
  5. Spinal fusion
    • Spinal fusion aids in the stabilization of the spine, particularly following surgeries, such as laminectomy.
    • Following a discectomy, your surgeon may use screws or rods to connect two or more of your vertebrae.
    • Your vertebrae will develop and fuse during this time to produce a robust, secure structure.
    • This surgery is frequently performed on patients who have lumbar degenerative disc disease, which is caused by decaying discs in the lower back.
    • Recovery may take up to a year, and there is a danger of limited spinal mobility.
  6. Artificial disc replacement
    • Artificial disc replacement surgery is an alternative to spinal fusion. The herniated disc is removed and replaced with an artificial disc by your surgeon.
    • In comparison to spinal fusion, it allows for greater spine movement, less stress on surrounding discs, and a shorter recovery period.

With medical advancements, surgery has become the preferred option to achieve better short and long-term outcomes. Various disc herniation surgeries have been demonstrated to safely and effectively treat chronic back and neck pain.

4 benefits of surgical treatment for herniated disc

Surgery is used to treat disc herniation that has not responded to conservative treatment. Various surgical methods for a herniated disc target the source of your pain problems directly.

  1. Faster pain relief
    • The full benefits of conservative therapy are usually felt within a few weeks to months.
    • By immediately relieving the extreme strain on your nerves, herniated disc surgery can alleviate pain immediately.
  2. Lasting effects
    • The herniated disc is removed during disc surgery, easing the tension on your nerves.
    • According to the researchers, having little to no symptoms of a herniated disc is more likely following surgical therapy.
  3. Improved mobility
    • When a herniated disc is surgically removed, the vertebrae in your spine can move more freely.
    • Everyday actions, such as bending, extending, and lifting, become less difficult.
  4. Faster recovery
    • Patients who have ruptured disc surgery early on have a shorter recovery period and increased mobility within a few weeks.

When you experience agonizing pain or trouble with bladder or bowel functions, surgical procedures could be the only alternative. Given the high success rate of herniation procedures, it has become increasingly advantageous to seek a long-term solution to lumbar disc herniation.

What is the outcome of patients with a herniated disc?

The outcome of patients with herniated discs depends on the treatment option that may be recommended by the doctors.

  • Nonsurgical treatment
    • Nonsurgical methods can relieve pain and discomfort caused by disc herniation.
    • Your symptoms may decrease in six weeks if you receive continuous therapy.
    • Conservative therapy, however, may fail in many circumstances.
  • Surgical treatment
    • A herniated disc can be treated with several surgeries. These procedures frequently have far-reaching, long-term impacts.
    • You may notice a big reduction in pain and a significant increase in physical function.
    • The success rate of disc herniation procedures has increased over time. A study found that disc herniation procedures in the neck had a 94 percent long-term success rate, whereas herniation surgeries in the lower back had a 78.9 percent success rate.

Remember that the longer you delay, the more difficult your path to recovery will be. If you are in pain and not enjoying your life to the fullest, talk to your doctor about the treatment choices that are best for you.

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Medically Reviewed on 5/4/2022
References
Image Source: iStock Image

WebMD. When Do I Need Surgery for a Herniated Disk? https://www.webmd.com/back-pain/surgery-for-herniated-disk

New Jersey Spinal Medicine & Surgery. When Does a Herniated Disc Require Surgery? http://www.njsms.net/2016/03/when-does-a-herniated-disc-require-surgery/

Yoon WW, Koch J. Herniated discs: When is surgery necessary? EFORT Open Rev. 2021;6(6):526-530. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246101/

eMedicine Health. How Bad Does a Herniated Disc Have to Be for Surgery? https://www.emedicinehealth.com/do_i_need_surgery_for_a_herniated_disc/article_em.htm

Open Access Government. How to treat a herniated disc without surgery. https://www.openaccessgovernment.org/treat-herniated-disc/64807/