“Is surgery necessary for herniated disk?”
I have a herniated disk in my lumbar area. Is surgery really necessary? Is there anything else I can do?
18 Answers
Most discs resolve over time. Managing symptoms with steroids, injections, physio, traction etc can help avoid surgery. Risks of surgery are not great but for me the main and rarely discussed surgical risk is that surgical scar tissue can lead to a greater pain problems down the road than the initial problem. Also if someone suggests a fusion, that can lead to a greater problem down The road than the initial problem. I have found that very few “herniated” discs actually need surgery. Symptom recovery may or may not be faster with surgery but with the risk of further problems down the road.
Only if it is causing relevant symptoms. It is common to have a herniation which causes no problem. The main reasons to operate are if the disc is causing weakness in relevant muscles or if you have terrible pain in the leg (sciatica) which is not improving with time. If you only have pain, I would try and push through for 6 weeks. If it is a bit better at that stage, keep going another 6 weeks. If it's not improving, then surgery is likely to be needed. The pain is miserable....so three months is a long time to put up with it, but if you can get through, try. Keep walking and moving though.
Thank you for your question.
The majority of the cases with disc protrusion are treated conservatively (without an operation). It depends on the severity and persistence of the symptoms, the clinical picture with regards to weakness or other nerve problems on the examination and understanding the alternatives following a discussion with the spinal surgeon that you will select. Rarely, the operation is an emergency if the patients develop serious neurological problems such as bladder or bowel incontinence, numbness in the private area and inability to pass water.
The majority of the cases with disc protrusion are treated conservatively (without an operation). It depends on the severity and persistence of the symptoms, the clinical picture with regards to weakness or other nerve problems on the examination and understanding the alternatives following a discussion with the spinal surgeon that you will select. Rarely, the operation is an emergency if the patients develop serious neurological problems such as bladder or bowel incontinence, numbness in the private area and inability to pass water.
Not always. Most patients with herniated discs can be managed with nonoperative care. It is very important that you and your Primary Care doctor discuss your current complaints to ensure you have no "red flags." Then establish a care plan that will yield the highest results with the lowest risk for your situation. Can plans can be as simple as behavior modification with rest and anti-inflammatories but could also include physical therapy, chiropractic care, acupuncture and even interventional pain management. Hope you feel better soon!
There are many people who live with herniated disc. The question to ask yourself is the herniated disc causing you pain and is there functional issues beginning to manifest such as foot drop, bowel or bladder inconvenience. Any of these symptoms is an emergency situation that needs to be addressed immediately.
Physical therapy, anti inflammatory meds, steroid injections and time. Sometimes up to more than 60% of patients will improve.
It depends on the size of the disc and on your symptoms and on whether you have any motor deficit with it or any Bowel or bladder symptoms, so if its large and or causing severe pain for more than 3 months and if u have deficits with it motor and or bowel and bladder then yes more than likely you will need surgery but if not then most likely you wont need surgery but it also depends on where you are in the current flare up cycle and whether you tried other non surgical methods eg physiotherapy and avoidance of exacerbating factors.
The answer to this question depends on many factors. A simple answer is that a disk herniation in the lumbar region in and of itself does NOT always require surgery. In some patients, the disk herniation is so large that nerves are compressed in such a way that the patient has significant weakness, sensory loss or even incontinence (trouble controlling bowel or bladder function) -- in these cases surgery is required on an urgent basis.
However, in most patients, the herniated disk may cause only pain (especially in the leg) -- if there is no weakness, or bowel/bladder incontinence, surgery can often be avoided and the pain treated with analgesics, exercise, weight loss and time.
However, in most patients, the herniated disk may cause only pain (especially in the leg) -- if there is no weakness, or bowel/bladder incontinence, surgery can often be avoided and the pain treated with analgesics, exercise, weight loss and time.
Jacob Januszewski
Neurosurgeon
Surgery is not always necessary for a herniated disk. In most circumstances, when pain or nubmness down your leg is the only symptom, conservative therapy with pain management (such as epidural steroid injections, facet blocks, foraminal injections, non-steroidal anti-inflammatory medications) and physical therapy for at least 3 months should be attempted. If conservative therapy does not improve symptoms only then surgery becomes an option.
There are situations, however, when a herniated disc may become a neurosurgical emergency with urgent surgery as the only option. In a setting of acute leg/foot weakness, bowel or bladder incontinence, or numbness around your groin area or upper inner thighs, MRI should be immediately performed and if a large disc herniation is diagnosed surgery should be performed within 24 to 48 hours. This is called "cauda equina" syndrome and is a neurosurgical emergency. Cauda equina does not occur with every disc herniation but it can occur in any age group and in people of any fitness level.
There are situations, however, when a herniated disc may become a neurosurgical emergency with urgent surgery as the only option. In a setting of acute leg/foot weakness, bowel or bladder incontinence, or numbness around your groin area or upper inner thighs, MRI should be immediately performed and if a large disc herniation is diagnosed surgery should be performed within 24 to 48 hours. This is called "cauda equina" syndrome and is a neurosurgical emergency. Cauda equina does not occur with every disc herniation but it can occur in any age group and in people of any fitness level.
Typically you would want to start with the least invasive treatments such
as physical therapy or chiropractic treatments. If those fail, then
consider more invasive treatments such as injections (epidural, facet). If
all else fails, then surgery. Exceptions would be if you are experiencing
weakness or bowel and bladder urgency/incontinence. In those cases, your
surgeon will talk to you about having surgery right away.
Typically you would know if therapy is helping within the first two weeks.
You may need up to two injections to see their full benefit.
as physical therapy or chiropractic treatments. If those fail, then
consider more invasive treatments such as injections (epidural, facet). If
all else fails, then surgery. Exceptions would be if you are experiencing
weakness or bowel and bladder urgency/incontinence. In those cases, your
surgeon will talk to you about having surgery right away.
Typically you would know if therapy is helping within the first two weeks.
You may need up to two injections to see their full benefit.
Surgery is not always necessary for a herniated disk. First option is usually rest and time. 2nd option consists of physical therapy and/or injections. If you have unbearable pain or profound weakness, surgery may be necessary.
No. Surgery is usually the last resort unless you have weakness or other severe neurological symptoms. Most disk herniations can be treated effectively with a combination of conservative treatments. This usually involves medicines, physical therapy/chiropractic treatment, and Pain Management for injection therapies. Your primary care doctor usually is all that is required to make the appropriate referrals, but if you are concerned or do not have a PMD, then seek consultation for a neurologist or a spine specialist (neuro or orthopedic surgeon) to get you started on the road towards recovery.
Hello and thank you for the question.
A herniated disc in and of itself does not necessitate surgery as
treatment.
Conservative therapy includes:
Physiotherapy
Weight loss
Core strengthening
Epidural steroid injections
Hope that answers your Q
Thx,
Dr. Lamki
A herniated disc in and of itself does not necessitate surgery as
treatment.
Conservative therapy includes:
Physiotherapy
Weight loss
Core strengthening
Epidural steroid injections
Hope that answers your Q
Thx,
Dr. Lamki
Whether or not surgery is "necessary" for a herniated disk depends on many factors. First off, what are the symptoms and what are the physical finding on examination. Is there only back pain ( or neck pain, depending on the location of the herniated disk} or is there also radiating leg pain (sciatica) or arm pain which might indicate nerve pressure. Abnormal findings on examination such as numbness or loss of feeling in the distribution of one or more nerve roots, weakness of a leg or arm or in the case of very large disk herniatiions, evidence of pressure on the spinal cord would tend toward a recommendation for surgery. The size or prominence of a herniated disk on an MRI scan is usually not the best indicator of whether or not surgery is indicated or whether the problem can be managed by conservative means such as physical therapy, modification of physical activity, use of anti- inflammatory medications, etc. A good medical history, physical examination and consultation with a surgeon experienced in spine surgery should be accomplished, in order to make such a decision. Be a little bit suspicious of physicians advertising themselves as "spine surgeons!"
It would depend on what symptoms are present. Any problem with weakness, numbness, difficulty with walking, or bowel or bladder dysfunction with potentially require surgical treatment to relieve the pressure on the nerve structures that are causing this. If symptom is primarily pain and there are no neurologic symptoms or deficits then physical therapy, smoking cessation, and analgesia with anti-inflammatory's may be all you need. A pain clinic evaluation with potential selective nerve root injections may also give relief of the pain so that physical therapy may then control the symptoms long-term.
Herniated discs are quite prevalent in the general population. Not every herniated disc requires surgery. Some disc herniate as the normal aging process takes place in our spines. Unless the herniated disc is compressing a nerve and given you significant pain, then it does not need to be addressed surgically. Additionally, many disc shrink and desiccate with time if left alone.
Not every patient who has herniated disc problems requires an operation.
The surgical indication depends on many factors.
The surgical indication depends on many factors.
Not all herniated discs require spinal surgery. The decision to undergo surgery is based on your clinical and radiographic examination. Your spine surgeon would be the best person to make that recommendation after having the opportunity to examine you and evaluate the radiological studies.
