Lumbar Herniated Disc: Should I Have Surgery?
Lumbar Herniated Disc: Should I Have Surgery?Skip to the navigationYou may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Lumbar Herniated Disc: Should I Have Surgery?Get the factsYour options- Have surgery for your herniated
disc now.
- Don't have surgery now. Try things like a change in the way you do your activities, medicines to manage pain, exercise, physical therapy, or steroid injections instead.
This decision aid is for you if your herniated disc is
in your low back and your symptoms have lasted a few weeks. It does not cover information about a herniated disc in the neck area of the
spine (cervical disc herniation). Key points to remember- A herniated disc in the lower back is a common cause of back and leg pain. For most people, symptoms get better over time, with or without treatment.
- Many people are able to manage their symptoms with things like changes in the way they do their activities, medicines to manage pain, exercise, physical therapy, or steroid injections. If one of these things doesn't work, you can try something else or combine some of them.
- Surgery may relieve your pain faster than nonsurgical treatments. For symptoms that have lasted at least 6 weeks and that make it hard to do your normal activities, surgery is an option when other treatments haven't helped.
- Over the long term, surgery and nonsurgical treatments work about the same to reduce pain and other symptoms.
-
Back surgery has some risks, including infection, nerve damage, and the chance that the surgery won't relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.
- 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.
FAQs 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
physical therapy 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. Acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain. Be safe with medicines. Read and follow all instructions on the label.
- 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.
- Physical therapy. 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.
- Steroid injections. These are shots that might be recommended for some people if other nonsurgical treatments haven't worked. The shots may ease leg pain by reducing inflammation in the nerve root. These shots may work for some people, but not for everyone. And when they work, they only help relieve symptoms for a short time.
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 nonsurgical treatment, that's a good
sign that your body will keep healing 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 nonsurgical treatment. But overall most people felt better with or without surgery.footnote 2 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 nonsurgical group) was assigned to try nonsurgical treatments for 6 months, followed by surgery if their symptoms didn't improve. When asked about their recovery 2 months after surgery or the start of nonsurgical treatment, people in the surgery group felt better (closer to complete recovery) than people in the nonsurgical group. But after 1 year, both treatment groups rated their recovery about the same.footnote 3 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 slight risk of damaging nerves or
the spine during surgery.
- Some people form a lot of scar tissue in
the area of the surgery. That tissue can press against nerves and cause pain.
- There is some risk of infection, which may cause more damage. An
infection may require antibiotics and another surgery.
- 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.
The numbers in this section are for discectomy (standard discectomy and microdiscectomy), the most common surgery for herniated disc. Symptom improvement with and without back surgeryfootnote 2 | With surgery | With nonsurgical treatment |
|---|
| Symptom-free or almost symptom-free within 3 months | 66 out of 100 people | 62 out of 100 people | | Symptom-free or almost symptom-free within 1 year | 76 out of 100 people | 67 out of 100 people | | Symptom-free or almost symptom-free within 2 years | 76 out of 100 people | 69 out of 100 people | How people rated their recovery on a 7-point scale, where "1" is complete recovery and "7" is worse symptomsfootnote 3 | People assigned to have surgery soon | People assigned to try nonsurgical treatments for 6 months (followed by surgery if their symptoms didn't improve) |
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| At 2 months | On average, people rated their recovery as 2.2. | On average, people rated their recovery as 3.1. | | At 1 year | On average, people rated their recovery as 1.9. | On average, people rated their recovery as 2.1. | Examples of serious risks of surgery for herniated disc footnote 4| Serious risks | |
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| 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. | | Nerve damage | 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. | | Surgery doesn't relieve symptoms, or new symptoms occur | About 4 to 10 out of 100 people who had surgery went on to have another surgery for a herniated disc. | BenefitsThere is no high-quality evidence showing that surgery is more helpful than nonsurgical treatment for a lumbar herniated disc. 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 nonsurgical treatment. But overall, most people felt better with or without surgery.footnote 2 Within 3 months: - 66 people out of 100 who had surgery had no symptoms or almost no symptoms. This means that 34 still had some symptoms.
- 62 people out of 100 who had nonsurgical treatment had no symptoms or almost no symptoms. This means that 38 still had some symptoms.
Within 1 year: - 76 people out of 100 who had surgery had no symptoms or almost no symptoms. This means that 24 still had some symptoms.
- 67 people out of 100 who had nonsurgical treatment had no symptoms or almost no symptoms. This means that 33 still had some symptoms.
After 2 years: - 76 people out of 100 who had surgery had no symptoms or almost no symptoms. This means that 24 still had some symptoms.
- 69 people out of 100 who had nonsurgical treatment had no symptoms or almost no symptoms. This means that 31 still had some symptoms.
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 nonsurgical group) was assigned to try nonsurgical treatments for 6 months, followed by surgery if their symptoms didn't improve. When asked about their recovery 2 months after surgery or the start of nonsurgical treatment, people in the surgery group felt better (closer to complete recovery) than people in the nonsurgical group. But after 1 year, both treatment groups rated their recovery about the same.footnote 3 Using a 7-point scale, where "1" is complete recovery and "7" is worse symptoms: - At 2 months:
- On average, people in the surgery group rated their recovery as 2.2.
- On average, people in the nonsurgical group rated their recovery as 3.1.
- At 1 year:
- On average, people in the surgery group rated their recovery as 1.9.
- On average, people in the nonsurgical group rated their recovery as 2.1.
RisksLike most surgeries, back surgery may have some risks. Take a group of 100 people who have back surgery. The more serious risks include: 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 4 Nerve damage: 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 4 Having symptoms that don't get better, or having 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 4 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.
Compare your options | |
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What is usually involved? |
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What are the benefits? |
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What are the risks and side effects? |
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Have herniated disc
surgery nowHave herniated disc
surgery now- You are asleep or numb during the
surgery.
- You will probably stay in the hospital overnight.
- Surgery may relieve your pain faster than nonsurgical treatments. But over the long term, surgery and nonsurgical treatments work about the same to reduce pain and other symptoms.
- With surgery, most people can go back to work
or their other activities sooner.
- There is a slight risk of damaging the spine or
nerves.
- All surgery has some risks, including bleeding, infection, risks from anesthesia, and 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.
- You may not be able to return to all of your normal activities for at least several months.
Don't have surgery now. Use nonsurgical
treatments instead.
Don't have surgery now. Use nonsurgical
treatments instead.- You try to manage your symptoms with things like changes in the way you do your activities, medicines to manage pain, exercise, physical therapy, or steroid injections.
- Many people are able to manage their symptoms with things like changes in the way they do their activities, medicines to manage pain, exercise, physical therapy, or steroid injections.
- You avoid the cost and risks of surgery.
- Over the long term, nonsurgical treatments and surgery work about the same to reduce pain or other symptoms.
- Pain relief
comes more slowly than with surgery.
- If other treatments don't work, you may still have pain that makes it hard for you to do your daily activities.
- Some medicines you take for pain may have side effects.
- Your symptoms don't get better or get worse even with other treatments.
I injured
my back working in the garden a few weeks ago. Based on the symptoms I'm
having, my doctor says it's pretty likely that I have a herniated disc. From
what I understand, the pain and leg symptoms will probably go away over time,
but I can't wait that long. My doctor says that the surgery will probably help
me recover faster, even though over the long term it might not make any
difference. The short term is what's important to me right now. I can
accept the potential risks, so I'm going ahead with tests and moving forward
with the surgery. Surgery has always made me nervous, even
though I've never had a bad experience with it myself. I just prefer not to
have surgery if I have any other option available. The pain and other symptoms
from my herniated disc are getting better, even if it's happening slowly. My
doctor said that it is reasonable for me to just keep doing home treatment and
take better care of my back. The pain
from my herniated disc is the worst pain I have ever felt. My leg feels like it
is on fire. I know that isn't true for everyone who has a herniated disc, but
it sure is in my case. I'm willing to try a month or so of conservative
treatment. But if there isn't a dramatic improvement, my doctor has agreed to
go ahead with plans for surgery. I'm lucky,
because my company has allowed me to take a job in another department where I
don't have to lift and where I can move around if I need to during the day. If
I wasn't able to do that, or if the pain was really bad, I would definitely
have had surgery. But this way I can keep working while my back heals on its
own. The pain is definitely still there, but it's manageable. I expect that
over time I will be able to return to most of my normal work and recreational
activities. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for a herniated disc now Reasons not to have surgery now I understand that surgery has risks. But I am comfortable with the idea of having back surgery, because there is a chance that it might help. I don't like the idea of surgery at all, because of the risks and the chance that it might not help. More important Equally important More important I've tried exercises, medicines, and working with a physical therapist for a few months, and I don't think they have helped me. I think the exercises I've been doing or the medicines I'm taking are starting to help. More important Equally important More important I am in a lot of pain. I don't see how I can stand it much longer. My pain isn't bad enough that I need to have surgery right now. More important Equally important More important It's very important that I get my pain under control so that I can go back to work as soon as possible. Time is not a problem for me. If I get better slowly using exercises and/or medicine, that's okay with me. More important Equally important More important I'm not worried about how much this surgery will cost. I don't have insurance and don't see how I can afford this surgery. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery for herniated disc now NOT having surgery now Leaning toward Undecided Leaning toward What else do you need to make your decision?1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure Your SummaryHere's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Next stepsWhich way you're leaningHow sure you areYour commentsKey concepts that you understoodKey concepts that may need reviewCredits | Author | Healthwise Staff |
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| Primary Medical Reviewer | William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
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| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
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| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
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| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
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| Specialist Medical Reviewer | Robert B. Keller, MD - Orthopedics |
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| Specialist Medical Reviewer | Steven J. Atlas, MD, MPH - Internal Medicine |
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References Citations - Jacobs WCH, et al. (2012) Surgical techniques for sciatica due to herniated disc, a systematic review. European Spine Journal, 21(11): 2232-2251. DOI: 10.1007/s00586-012-2422-9. Accessed October 15, 2015.
- Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): A randomized trial. JAMA, 296(20): 2441-2450.
- Peul WC, et al. (2007). Surgical versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 356(22): 2245-2256.
- Shriver MF, et al. (2015). Lumbar microdiscectomy complication rates: A systematic
review and meta-analysis. Neurosurgical Focus, 39(4): 1232-1241. DOI: 10.3171/2015.7.focus15281. Accessed October 15, 2015.
Other Works Consulted - Jacobs WC, et al. (2011). Surgery versus conservative management of sciatica due to a lumbar herniated disc: A systematic review. European Spine Journal, 20(4): 513-522.
- Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Lequin MB, et al. (2013). Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open, 3(5). pii: e002534. DOI: 10.1136/bmjopen-2012-002534. Accessed October 15, 2015.
- Lurie JD, et al. (2015). Surgical versus nonoperative treatment for lumbar disc herniation: Eight-year results for the spine patient outcomes research trial. Spine, 39(1): 3-16. DOI: 10.1097/BRS.0000000000000088. Accessed October 5, 2015.
- Rasouli MR, et al. (2014). Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database of Systematic Reviews (9). DOI: 10.1002/14651858.CD010328.pub2. Accessed October 15, 2015.
- Tay BKB, et al. (2014). Disorders, diseases, and injuries of the spine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 156-229. New York: McGraw-Hill.
- Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): Observational cohort. JAMA, 296(20): 2451-2459.
- Weinstein JN, et al. (2008). Surgical versus nonoperative treatment for lumbar disc herniation: Four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine, 33(25): 2789-2800. DOI: 10.1097/BRS.0b013e31818ed8f4. Accessed November 18, 2015.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Lumbar Herniated Disc: Should I Have Surgery?Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. - Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the FactsYour options- Have surgery for your herniated
disc now.
- Don't have surgery now. Try things like a change in the way you do your activities, medicines to manage pain, exercise, physical therapy, or steroid injections instead.
This decision aid is for you if your herniated disc is
in your low back and your symptoms have lasted a few weeks. It does not cover information about a herniated disc in the neck area of the
spine (cervical disc herniation). Key points to remember- A herniated disc in the lower back is a common cause of back and leg pain. For most people, symptoms get better over time, with or without treatment.
- Many people are able to manage their symptoms with things like changes in the way they do their activities, medicines to manage pain, exercise, physical therapy, or steroid injections. If one of these things doesn't work, you can try something else or combine some of them.
- Surgery may relieve your pain faster than nonsurgical treatments. For symptoms that have lasted at least 6 weeks and that make it hard to do your normal activities, surgery is an option when other treatments haven't helped.
- Over the long term, surgery and nonsurgical treatments work about the same to reduce pain and other symptoms.
-
Back surgery has some risks, including infection, nerve damage, and the chance that the surgery won't relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.
- 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.
FAQs What is a herniated disc?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. What kinds of procedures are done for a herniated disc?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.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
physical therapy and home exercises. What nonsurgical treatments are used for a herniated disc?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. Acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain. Be safe with medicines. Read and follow all instructions on the label.
- 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.
- Physical therapy. 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.
- Steroid injections. These are shots that might be recommended for some people if other nonsurgical treatments haven't worked. The shots may ease leg pain by reducing inflammation in the nerve root. These shots may work for some people, but not for everyone. And when they work, they only help relieve symptoms for a short time.
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 nonsurgical treatment, that's a good
sign that your body will keep healing without surgery. Often the body
reabsorbs the material from the disc, which helps the pain go away. This
process is called
resorption. How well does herniated disc surgery work?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 nonsurgical treatment. But overall most people felt better with or without surgery.2 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 nonsurgical group) was assigned to try nonsurgical treatments for 6 months, followed by surgery if their symptoms didn't improve. When asked about their recovery 2 months after surgery or the start of nonsurgical treatment, people in the surgery group felt better (closer to complete recovery) than people in the nonsurgical group. But after 1 year, both treatment groups rated their recovery about the same.3 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. What are the risks of surgery?Most people have no
problems with back surgery for a herniated disc. But
as for most surgeries, there are some risks: - There is a slight risk of damaging nerves or
the spine during surgery.
- Some people form a lot of scar tissue in
the area of the surgery. That tissue can press against nerves and cause pain.
- There is some risk of infection, which may cause more damage. An
infection may require antibiotics and another surgery.
- 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.
What do numbers tell us about the benefits and risks of back surgery?The numbers in this section are for discectomy (standard discectomy and microdiscectomy), the most common surgery for herniated disc. Symptom improvement with and without back surgery2 | With surgery | With nonsurgical treatment |
|---|
| Symptom-free or almost symptom-free within 3 months | 66 out of 100 people | 62 out of 100 people | | Symptom-free or almost symptom-free within 1 year | 76 out of 100 people | 67 out of 100 people | | Symptom-free or almost symptom-free within 2 years | 76 out of 100 people | 69 out of 100 people | How people rated their recovery on a 7-point scale, where "1" is complete recovery and "7" is worse symptoms3 | People assigned to have surgery soon | People assigned to try nonsurgical treatments for 6 months (followed by surgery if their symptoms didn't improve) |
|---|
| At 2 months | On average, people rated their recovery as 2.2. | On average, people rated their recovery as 3.1. | | At 1 year | On average, people rated their recovery as 1.9. | On average, people rated their recovery as 2.1. | Examples of serious risks of surgery for herniated disc 4| Serious risks | |
|---|
| 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. | | Nerve damage | 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. | | Surgery doesn't relieve symptoms, or new symptoms occur | About 4 to 10 out of 100 people who had surgery went on to have another surgery for a herniated disc. | BenefitsThere is no high-quality evidence showing that surgery is more helpful than nonsurgical treatment for a lumbar herniated disc. 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 nonsurgical treatment. But overall, most people felt better with or without surgery.2 Within 3 months: - 66 people out of 100 who had surgery had no symptoms or almost no symptoms. This means that 34 still had some symptoms.
- 62 people out of 100 who had nonsurgical treatment had no symptoms or almost no symptoms. This means that 38 still had some symptoms.
Within 1 year: - 76 people out of 100 who had surgery had no symptoms or almost no symptoms. This means that 24 still had some symptoms.
- 67 people out of 100 who had nonsurgical treatment had no symptoms or almost no symptoms. This means that 33 still had some symptoms.
After 2 years: - 76 people out of 100 who had surgery had no symptoms or almost no symptoms. This means that 24 still had some symptoms.
- 69 people out of 100 who had nonsurgical treatment had no symptoms or almost no symptoms. This means that 31 still had some symptoms.
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 nonsurgical group) was assigned to try nonsurgical treatments for 6 months, followed by surgery if their symptoms didn't improve. When asked about their recovery 2 months after surgery or the start of nonsurgical treatment, people in the surgery group felt better (closer to complete recovery) than people in the nonsurgical group. But after 1 year, both treatment groups rated their recovery about the same.3 Using a 7-point scale, where "1" is complete recovery and "7" is worse symptoms: - At 2 months:
- On average, people in the surgery group rated their recovery as 2.2.
- On average, people in the nonsurgical group rated their recovery as 3.1.
- At 1 year:
- On average, people in the surgery group rated their recovery as 1.9.
- On average, people in the nonsurgical group rated their recovery as 2.1.
RisksLike most surgeries, back surgery may have some risks. Take a group of 100 people who have back surgery . The more serious risks include: 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.4 Nerve damage: 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.4 Having symptoms that don't get better, or having 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.4 Why might your doctor recommend herniated disc surgery?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.
2. Compare your options| | Have herniated disc
surgery now | Don't have surgery now. Use nonsurgical
treatments instead. |
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| What is usually involved? | - You are asleep or numb during the
surgery.
- You will probably stay in the hospital overnight.
| - You try to manage your symptoms with things like changes in the way you do your activities, medicines to manage pain, exercise, physical therapy, or steroid injections.
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| What are the benefits? | - Surgery may relieve your pain faster than nonsurgical treatments. But over the long term, surgery and nonsurgical treatments work about the same to reduce pain and other symptoms.
- With surgery, most people can go back to work
or their other activities sooner.
| - Many people are able to manage their symptoms with things like changes in the way they do their activities, medicines to manage pain, exercise, physical therapy, or steroid injections.
- You avoid the cost and risks of surgery.
- Over the long term, nonsurgical treatments and surgery work about the same to reduce pain or other symptoms.
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| What are the risks and side effects? | - There is a slight risk of damaging the spine or
nerves.
- All surgery has some risks, including bleeding, infection, risks from anesthesia, and 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.
- You may not be able to return to all of your normal activities for at least several months.
| - Pain relief
comes more slowly than with surgery.
- If other treatments don't work, you may still have pain that makes it hard for you to do your daily activities.
- Some medicines you take for pain may have side effects.
- Your symptoms don't get better or get worse even with other treatments.
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Personal storiesPersonal stories about herniated disc surgery
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I injured my back working in the garden a few weeks ago. Based on the symptoms I'm having, my doctor says it's pretty likely that I have a herniated disc. From what I understand, the pain and leg symptoms will probably go away over time, but I can't wait that long. My doctor says that the surgery will probably help me recover faster, even though over the long term it might not make any difference. The short term is what's important to me right now. I can accept the potential risks, so I'm going ahead with tests and moving forward with the surgery." "Surgery has always made me nervous, even though I've never had a bad experience with it myself. I just prefer not to have surgery if I have any other option available. The pain and other symptoms from my herniated disc are getting better, even if it's happening slowly. My doctor said that it is reasonable for me to just keep doing home treatment and take better care of my back." "The pain from my herniated disc is the worst pain I have ever felt. My leg feels like it is on fire. I know that isn't true for everyone who has a herniated disc, but it sure is in my case. I'm willing to try a month or so of conservative treatment. But if there isn't a dramatic improvement, my doctor has agreed to go ahead with plans for surgery." "I'm lucky, because my company has allowed me to take a job in another department where I don't have to lift and where I can move around if I need to during the day. If I wasn't able to do that, or if the pain was really bad, I would definitely have had surgery. But this way I can keep working while my back heals on its own. The pain is definitely still there, but it's manageable. I expect that over time I will be able to return to most of my normal work and recreational activities." 3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for a herniated disc now Reasons not to have surgery now I understand that surgery has risks. But I am comfortable with the idea of having back surgery, because there is a chance that it might help. I don't like the idea of surgery at all, because of the risks and the chance that it might not help. More important Equally important More important I've tried exercises, medicines, and working with a physical therapist for a few months, and I don't think they have helped me. I think the exercises I've been doing or the medicines I'm taking are starting to help. More important Equally important More important I am in a lot of pain. I don't see how I can stand it much longer. My pain isn't bad enough that I need to have surgery right now. More important Equally important More important It's very important that I get my pain under control so that I can go back to work as soon as possible. Time is not a problem for me. If I get better slowly using exercises and/or medicine, that's okay with me. More important Equally important More important I'm not worried about how much this surgery will cost. I don't have insurance and don't see how I can afford this surgery. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important 4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery for herniated disc now NOT having surgery now Leaning toward Undecided Leaning toward 5. What else do you need to make your decision?
Check the facts
1.
If I have pain because of a herniated disc, I probably need surgery. That's right. For most people, symptoms get better over time, with or without treatment. And many people are able to manage their symptoms with things like changes in the way they do their activities, medicines to manage pain, exercise, physical therapy, or steroid injections. 2.
If my symptoms haven't gotten better, surgery might help me get better faster. That's right. Surgery may relieve your pain faster than nonsurgical treatments. For symptoms that have lasted at least 6 weeks and that make it hard to do your normal activities, surgery is an option when other treatments haven't helped. 3.
Years from now, I will probably feel just as good without surgery as I would if I have surgery. That's right. Over the long term, surgery and nonsurgical treatments work about the same to reduce pain and other symptoms. Decide what's next1.
Do you understand the options available to you? 2.
Are you clear about which benefits and side effects matter most to you? 3.
Do you have enough support and advice from others to make a choice? Certainty1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure 2.
Check what you need to do before you make this decision. Credits | By | Healthwise Staff |
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| Primary Medical Reviewer | William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
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| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
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| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
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| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
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| Specialist Medical Reviewer | Robert B. Keller, MD - Orthopedics |
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| Specialist Medical Reviewer | Steven J. Atlas, MD, MPH - Internal Medicine |
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References Citations - Jacobs WCH, et al. (2012) Surgical techniques for sciatica due to herniated disc, a systematic review. European Spine Journal, 21(11): 2232-2251. DOI: 10.1007/s00586-012-2422-9. Accessed October 15, 2015.
- Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): A randomized trial. JAMA, 296(20): 2441-2450.
- Peul WC, et al. (2007). Surgical versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 356(22): 2245-2256.
- Shriver MF, et al. (2015). Lumbar microdiscectomy complication rates: A systematic
review and meta-analysis. Neurosurgical Focus, 39(4): 1232-1241. DOI: 10.3171/2015.7.focus15281. Accessed October 15, 2015.
Other Works Consulted - Jacobs WC, et al. (2011). Surgery versus conservative management of sciatica due to a lumbar herniated disc: A systematic review. European Spine Journal, 20(4): 513-522.
- Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Lequin MB, et al. (2013). Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open, 3(5). pii: e002534. DOI: 10.1136/bmjopen-2012-002534. Accessed October 15, 2015.
- Lurie JD, et al. (2015). Surgical versus nonoperative treatment for lumbar disc herniation: Eight-year results for the spine patient outcomes research trial. Spine, 39(1): 3-16. DOI: 10.1097/BRS.0000000000000088. Accessed October 5, 2015.
- Rasouli MR, et al. (2014). Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database of Systematic Reviews (9). DOI: 10.1002/14651858.CD010328.pub2. Accessed October 15, 2015.
- Tay BKB, et al. (2014). Disorders, diseases, and injuries of the spine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 156-229. New York: McGraw-Hill.
- Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): Observational cohort. JAMA, 296(20): 2451-2459.
- Weinstein JN, et al. (2008). Surgical versus nonoperative treatment for lumbar disc herniation: Four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine, 33(25): 2789-2800. DOI: 10.1097/BRS.0b013e31818ed8f4. Accessed November 18, 2015.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.Current as of:
March 21, 2017 Jacobs WCH, et al. (2012) Surgical techniques for sciatica due to herniated disc, a systematic review. European Spine Journal, 21(11): 2232-2251. DOI: 10.1007/s00586-012-2422-9. Accessed October 15, 2015. Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): A randomized trial. JAMA, 296(20): 2441-2450. Peul WC, et al. (2007). Surgical versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 356(22): 2245-2256. Shriver MF, et al. (2015). Lumbar microdiscectomy complication rates: A systematic
review and meta-analysis. Neurosurgical Focus, 39(4): 1232-1241. DOI: 10.3171/2015.7.focus15281. Accessed October 15, 2015. Last modified on: 8 September 2017
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