Lumbar Herniated Disc: Should I Have Surgery?, DecisionPoint Information

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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 facts

Your options

Have surgery for your herniated disc.
Don't have surgery.

This decision guide is for you if your herniated disc is in your low back. It does not cover information about herniated discs in the neck area of the spine (cervical disc herniation).

Key points to remember

Most people get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.
Surgery may be a good choice if you have sciatica —severe pain, numbness, or weakness in your buttock and leg—that has not improved with nonsurgical treatment.
If you have medium to very bad pain that does not seem to be getting better over a few months of time, you will probably feel better sooner if you have surgery. But over time your ability to do your daily activities will probably be about the same whether you have surgery or not.
If a doctor recommends that you have surgery, it's a good idea to get a second opinion. You need to get as much information as possible before you make this decision.
Surgery for a herniated disc doesn't usually cause problems. But there is a slight risk of damaging nerves or the spine during surgery. Other possible problems include problems from the anesthesia and from infection that causes more damage.
Your doctor may recommend several weeks of physical therapy and home exercises after surgery.

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.

If the herniated disc is in the lower back (lumbar spine), it can cause pain and numbness in the buttock and down the leg. This is called sciatica (say "sy-AT-ih-kuh"). Sciatica is the most common symptom of a herniated disc in the low back.

Usually a herniated disc will heal on its own over time.

What kinds of surgery are done for a herniated disc?

The most common surgeries are:

Discectomy	It removes material that is pressing on a nerve root or the spinal cord. It is the surgery that works best for people who still have very bad pain ( sciatica ) after trying other treatments. Often it can be done as microdiscectomy, which uses a smaller incision and causes less damage to surrounding tissue.
Percutaneous discectomy	It also removes material pressing on a nerve, but it is done by inserting a special tool through a very small incision. It doesn't work quite as well as a regular discectomy.¹
Laminotomy and laminectomy	They relieve pressure caused by age-related changes in the spine. Laminotomy removes some of the lamina, the thin part of the vertebrae that forms a protective arch over the spinal cord. Laminectomy removes most of or all of the lamina. It also may remove thickened tissue that is narrowing the spinal canal . They may be done at the same time as a discectomy, or separately.

Your doctor may recommend a rehabilitation program after surgery, which can include physical therapy and home exercises.

When is nonsurgical treatment used for a herniated disc?

Most herniated discs heal after a few months of nonsurgical treatment. This treatment can include:

A short period of rest.
Medicine for pain relief, including pain pills, muscle relaxants, and steroid shots.
Physical therapy.
An exercise program prescribed by a doctor.

If you are getting better after at least 4 weeks of nonsurgical treatment, that's a good sign that your body will continue to heal 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.

A SPORT study found that people were more likely to feel better if they had surgery or other treatment before they had more than 6 months of symptoms.²

Some people decide to have surgery because they need to go back to work or to their other activities as soon as possible. If your job doesn't require you to be very active, you can probably go back to work 2 to 4 weeks after surgery. If your job is physically demanding, you'll need to wait 8 to 12 weeks.

What are the risks of surgery?

Most people have no problems with back surgery for herniated discs. 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 are uncommon but can include trouble breathing, heart attack, stroke, and even death.

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.

Recovery rates with back treatments*
Recovery	With surgery	With nonsurgical treatment
Symptom-free or almost symptom-free within 3 months	50 to 60 out of 100	20 to 30 out of 100
Symptom-free or almost symptom-free within 1 year	90 to 95 out of 100	80 to 95 out of 100
Need for surgery within 4 years	10 out of 100	10 out of 100

Examples of serious risks with back surgery*
Serious risks	With standard discectomy	With microdiscectomy
Permanent nerve damage	10 to 20 out of 1,000	1 to 3 out of 1,000
Death	1 to 2 out of 1,000	1 out of 1,000

*Based on the best available evidence (evidence quality: borderline to inconclusive )

Benefits

There is no high-quality evidence showing that surgery is more helpful than nonsurgical treatment for a lumbar herniated disc. The quality of the evidence is borderline to inconclusive .

Take a group of 100 people who have sciatica caused by a herniated disc . The chances of having no symptoms or almost no symptoms 3 months later may be a little higher with surgery than with nonsurgical treatment:

With surgery, 50 to 60 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 40 to 50 may still have symptoms.
With nonsurgical treatment, 20 to 30 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 70 to 80 may still have symptoms.

After a year, the gap in recovery between those who used surgery and those who used nonsurgical treatment is much smaller.

At 1 year after surgery, 90 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 10 may still have symptoms.
After 1 year of nonsurgical treatment, 80 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 20 may still have some symptoms.

When it comes to the need for surgery within the next 4 years, there is no difference.

If they all have back surgery, 10 out of 100 people may need surgery again within 4 years.
If they all use nonsurgical treatment, 10 out of 100 people may need surgery within 4 years.

Risks

The evidence suggests that, like most surgeries, back surgery may have some risks. The risks may be higher for standard discectomy than for microdiscectomy, which uses a smaller incision and causes less tissue damage. The quality of the evidence about risks is borderline to inconclusive .

Take a group of 1,000 people who have back surgery . The more serious risks include:

Permanent nerve damage. With standard discectomy, 10 to 20 people out 1,000 may have lasting nerve damage, which means that 980 to 990 out of 1,000 may not. With microdiscectomy, the risk of nerve damage is lower: 1 to 3 people out of 1,000.
Death. With standard discectomy, 1 to 2 people out of 1,000 may die because of the surgery, which means that 998 to 999 may not die. With microdiscectomy, 1 person out of 1,000 may die because of the surgery.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.^3, ^4, ^5, ^6, ^7, ^8, ^9, ¹⁰ The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive .

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Why might your doctor recommend herniated disc surgery?

Your doctor might recommend surgery for your herniated disc if:

You have very bad leg pain, numbness, or weakness ( sciatica ) that keeps you from being able to do your daily activities.
Your leg symptoms do not get better with at least 4 weeks of nonsurgical treatment.
Your symptoms are getting worse.
You need to get better quickly because of your job.
Tests show that your herniated disc can be treated with surgery.
You are able to follow a rehabilitation program for a number of weeks after surgery.

2. Compare your options

	Have herniated disc surgery	Use nonsurgical treatments
What is usually involved?	You are asleep or numb during the surgery. You will probably stay in the hospital overnight.	You try rest, physical therapy, exercises, and medicines.
What are the benefits?	Surgery works well for many people with medium to very bad pain. Surgery offers faster pain relief than other treatment. With surgery, most people can go back to work sooner.	You avoid having surgery. Nonsurgical treatments work for most people. Research shows that 10 years after treatment, people who do not have surgery are just about as likely to be able to do their daily activities as people who have surgery.
What are the risks and side effects?	Surgery does not always work, or it may not work any better than other treatment. There is a slight risk of damaging the spine or nerves. There is some risk of infection. There are risks with anesthesia.	Pain relief comes more slowly than with surgery. If you take medicine for pain, you may have side effects that you don't like.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal 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 a lot faster, even though over the long term it might not make any difference. The short term is what's important to me right now, and I can accept the potential risks, so I'm going ahead with tests and moving forward with the surgery."

— Dean, age 39

"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. She also says that I'm not risking any serious problems by not having surgery."

— Mai-Li, age 57

"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 week or so of conservative treatment, but if there isn't a dramatic improvement, my doctor has agreed to go ahead with plans for surgery."

— Jane, age 46

"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."

— Javier, age 43

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

Reasons not to have surgery

I am comfortable with the idea of having back surgery.

I don't like the idea of surgery at all.

More important

Equally important

More important

I've tried exercises and medicines 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 operation will cost.

I don't have insurance and don't see how I can afford this operation.

More important

Equally important

More important

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

NOT having surgery

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer	Robert B. Keller, MD - Orthopedics

References

Citations

Hu SS, et al. (2006). Lumbar disc herniation section of Disorders, diseases, and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 246–249. New York: McGraw-Hill.
Rihn JA, et al. (2011). Duration of symptoms resulting from lumbar disc herniation: Effect on treatment outcomes. Journal of Bone and Joint Surgery, 93(20): 1906–1914.
Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Deyo RA (2007). Back surgery—Who needs it? New England Journal of Medicine, 356(22): 2239–2243.
Gibson JN, et al. (2007). Surgical interventions for lumbar disc prolapse: Updated Cochrane Review. Spine, 32(16): 1735–1747.
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. (2009). Herniated lumbar disc, search date 2009. Online version of Clinical Evidence : http:/www.clinicalevidence.com.
Peul WC, et al. (2007). Hague Spine Intervention Prognostic Study Group. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 356(22): 2245–2256.
Saal JA, et al. (1989). Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine, 14(4): 431–437.
Watters WC, et al. (2009). An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine Journal, 9(3): 240–257.

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Last Revised: August 25, 2012

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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