lumbar herniated disc: should i have surgery?

the bones that form the spine—your vertebrae—are cushioned by small, spongy discs. when these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. but when a disc is damaged, it may bulge or break open. this is called a herniated disc. it may also be called a slipped or ruptured disc.

a herniated disc doesn't always cause symptoms. but when it presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels.

a herniated disc in the lower back is a common cause of back and leg pain. sometimes it can cause pain and numbness in the buttock and down the leg. this is called sciatica (say "sy-at-ih-kuh"). for most people, symptoms get better over time, with or without treatment.

the goal of the procedures is to take the pressure off the nerve roots. this is usually done by removing disc material. this is called a discectomy.

there are different ways to remove disc material. they are:

• open discectomy. this is done through a large cut, called an incision, in your back.
• microdiscectomy. this is done through a smaller incision. it causes less damage to surrounding tissue.
• minimally invasive procedures. these are done through one or more tiny incisions in your back. your doctor can put special tools through the incisions, such as cutting or heating devices or lasers. these tools can cut or destroy part of the disc.

studies haven't shown noticeable differences in how well each of these procedures works. so you and your doctor will think about several things in deciding which treatment may be right for you. these include your particular body structure, your symptoms, which disc is herniated, what you prefer, and your doctor's expertise and experience.^{footnote 1}

in some cases, a small piece of bone from the affected vertebra may be removed. this small piece is called the lamina. it's the thin part of the vertebrae that forms a protective arch over the spinal cord. a procedure called a laminotomy removes some of the lamina. a laminectomy removes most of or all of the lamina. it also may remove thickened tissue that is narrowing the spinal canal. either of these procedures may be done at the same time as a discectomy, or separately.

your doctor may recommend a rehabilitation program after the procedure. this program may include physiotherapy and home exercises.

treatments other than surgery can often help you feel better, be more active, and avoid surgery. many people are able to manage their symptoms with things like:

• changing the way they do their activities. this means trying other ways of doing your activities that don't cause pain or make other symptoms worse. for example, if sitting makes symptoms worse, try standing up to do your tasks. or you can switch between sitting and standing.
• taking medicines to manage pain. medicines such as nsaids or acetaminophen are usually tried first. other medicines that are sometimes tried include stronger pain medicines or muscle relaxers. steroid shots are also sometimes used.
• exercise. aerobic exercise can help your symptoms. take a short walk (10 to 20 minutes) on a level surface (try to avoid slopes, hills, or stairs) every 2 to 3 hours. walk only distances you can manage without pain, especially leg pain.
• physiotherapy. it helps you learn stretching and strength exercises that may reduce pain and other symptoms. the goal of this treatment is to make your daily tasks and activities easier.

if one of these things doesn't work, you can try something else or combine some of them.

if you are getting better after at least 6 weeks of non-surgical treatment, that's a good sign that your symptoms may keep getting better without surgery. often the body reabsorbs the material from the disc, which helps the pain go away. this process is called resorption.

surgery for a lumbar (low back) herniated disc works well for many people, but not for everyone. for some people, it can get rid of all or most of their symptoms.

in a study of people who had sciatica caused by a herniated disc, the chances of having no symptoms or almost no symptoms 3 months to 2 years later was a little higher with surgery than with non-surgical treatment. but, overall, most people felt better with or without surgery.^{footnote 4}

in a study of people who had 6 to 12 weeks of severe sciatica related to a herniated disc, one group was assigned to have surgery soon (the surgery group). the other group (the non-surgical group) was assigned to try non-surgical treatments for 6 months, followed by surgery if their symptoms didn't improve. both groups were asked about their recovery 2 months after surgery or the start of non-surgical treatment. people in the surgery group felt better (closer to complete recovery) than people in the non-surgical group. but after 1 year, both treatment groups rated their recovery about the same.^{footnote 2}

if you don't choose surgery now, you can change your mind later if your symptoms haven't gotten better or have gotten worse even with other treatments. surgery seems to work just as well if it's done within 6 months after your symptoms started.

most people have no problems with back surgery for a herniated disc. but as for most surgeries, there are some risks.

• there is a risk of damaging nerves or the spine during surgery. also, some people form a lot of scar tissue in the area of the surgery. that tissue can press against nerves and cause pain. about 1 to 3 out of 100 people who had surgery had nerve root injury or new or worsening nerve-related problems, such as weakness, numbness, or tingling. this means that 97 to 99 did not have these problems.^{footnote 3}
• there is a risk of wound problems, including infection and hematoma (bad bruise). less than 1 to 2 out of 100 people who had surgery had an infection or some other wound problem. this means that 98 to more than 99 did not.^{footnote 3}
• serious side effects of anesthesia aren't common but can include trouble breathing, heart attack, stroke, and even death.
• there is a chance that the surgery won't relieve your symptoms. and even if you get better with surgery, there is a chance you may get new symptoms in the future. about 4 to 10 out of 100 people who had surgery went on to have another surgery for a herniated disc. this means that 90 to 96 did not.^{footnote 3}

your doctor might recommend surgery as an option for your herniated disc if:

• your symptoms have lasted at least 6 weeks and make it hard to do your normal activities, and other treatments haven't helped.
• you need to get better quickly because of your job or to get back to your other activities as soon as possible.
• you have leg weakness that is getting worse.
• you have bowel or bladder problems because of your herniated disc.