Is Surgery Always Necessary for A Herniated Disc?

At any one point in time, about 1% of the population deals with pain from a herniated disc. About one fourth of all people with back pain have a herniated disc, and about 90% of these occur in the lower back.

What is the natural history of a herniated disc? Do patients always need surgery, or can they get by non-operatively with various pain management options? Surgery is not always necessary for a herniated disc. There are certain instances where surgery is highly recommended, such as if a patient is experiencing an increased neurologic deficit from where the herniated disc is pushing on the nerve root. For instance if the patient has an L4-L5 herniated disc, the nerve root that is most commonly affected is the L5 nerve root. The L5 nerve root is essential in the patient's ability to lift up the foot. So if it is effective enough, the patient may be unable to lift up the foot and have what is known as a foot drop. Watching this for too long to see if it gets better is not such a great idea therefore surgery may be indicated if this does not get better within a month or two.

Often times physicians are able to prescribe muscle relaxants, painkillers, or have the patient undergo a series of epidural steroid injections. In conjunction with physical therapy, chiropractic treatment, or maybe even a series of spinal decompression treatments, the patient may be able to avoid surgery and get back to being much more functional. These treatments are effective over 90% of the time for a herniated disk with sciatica.

Epidural steroid injections work approximately 70% of the time for significant pain relief. They do not fix the problem of the herniated disc, but may be able to provide enough of a Band-Aid for pain relief while the body itself disintegrates the piece of disc material that is outside the area where it is supposed to be. Studies have shown that patients who undergo surgery for a herniated disc versus patients who are treated not operatively end up doing the same at the one-year point.

So unless it is absolutely necessary, patients who are experiencing sciatica from a herniated disc should undergo nonoperative treatment first. If the patient has difficulty with bowel or bladder control that represents a surgical emergency and should be treated right away. As mentioned, if the patient has a neurologic deficit or an increasing neurologic deficit, then surgery may be a good idea if relief is not seen sooner rather than later. But if it is simply pain that the patient is experiencing, then patients should treat the decision as a quality of life decision and not rush into surgery if nonoperative pain treatments are giving significant enough relief.