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SHOULD I HAVE SURGERY FOR A HERNIATED DISC?

Dr. Mersad Alimoradi 11 Oct 2021
SHOULD I HAVE SURGERY FOR A HERNIATED DISC?

Almost everyone has experienced back or neck pain at least once in their life. For some, it happens so often that they’ve learned to live with it.

You might have lifted something heavy in the wrong way or you might have stretched or twisted in an awkward position. These may sound harmless, but these are some of the ways you can develop a herniated disc.

A Herniated Disc is one of the most common problems that cause back pain. You may not feel it at first, but once it presses against the nerves in your back, you may start feeling pain. Herniation occurs when the discs between the bones of your spine slips and pushes into your spinal cord.

Fortunately, there are various ways to treat disc herniation - pain medication, physical therapy, and even steroid injections. Surgical procedures can also relieve the pain from a herniated disc and even prevent further damage.

Although surgery provides faster pain relief than most treatments, it isn't always the treatment of choice for most. If you’re having a tough time deciding between treatments, talk to your doctor about your best options and use this guide to help you choose which treatment suits you.

What Is A Herniated Disc?

Your spine is made up of bones called vertebrae stacked one on top of the other. In between these vertebrae are jelly-like intervertebral discs that are primarily composed of water and cartilages.

Intervertebral discs increase the flexibility of your spine, allowing you to bend easily without pain. Aside from providing structural support, intervertebral discs act as shock absorbers or cushions in your back to reduce stress from impact.

Disc Herniation is also known as “Slipped Disc” and usually occurs in the neck (cervical spine) or low back (lumbar spine).

Slipped disc occurs when the soft, jelly-like substance in the middle of the intervertebral disc (nucleus pulposus) slips out through a defect such as a tear in the outer layer of the disc (annulus fibrosus) and moves into your spinal canal.

The herniated disc can press against your spinal cord and nerve roots within your spinal canal, causing back, arms, or leg pain. The disc also releases chemical substances that contribute to inflammation of your nerves.

What Causes Disc Herniation?

Your body undergoes different changes as you age. Disc degeneration is the gradual deterioration of your intervertebral discs because of natural wear and tear.

In the young, discs have a high water content that allows the discs to be flexible. As we age, we lose more of that water content, losing that flexibility as well. This degeneration can lead your discs to lose most of their water content. With time, your discs will shrink, and the spaces in between the vertebrae become narrower.

Less flexible discs are more prone to tears or ruptures when you strain your back. When they tear, the nucleus pulposus or center of the disc slips out, leading to disc herniation.

Sometimes, strenuous back movements such as rapid turns, twists, or lifting a heavy item from the ground can cause a disc to become herniated. Herniation caused by a blow to the back or other traumatic events is a rare cause.

Symptoms Of A Herniated Disc

Herniation can occur at any part of your spine. However, most cases start at your lower back. Low back pain is often the first symptom of a slipped disc. But that’s not always the case.

There are different types of the herniation that present in different ways.

Contained Herniation

A contained herniation is most commonly known as “Bulging Disc.” It occurs due to pressure in between your vertebrae, causing your intervertebral discs to protrude outward.

In this case, the disc herniation may not present with any symptoms aside from back pain. The pressure on your vertebrae causes them to compress against your nerves leading to generally mild back pain.

Non-Contained Herniation

A non-contained herniated disc occurs when the center of the disc has been wholly extruded and is no longer contained in the disc’s outer layer. We now call this “Disc Extrusion.” This non-contained disc can pressure or irritate your spinal nerves causing extensive pain. Symptoms of non-contained disc herniation include:

  • Burning or stinging pain
  • Pain in the pelvis or leg
  • Severe back pain
  • Numbness or tingling in the arms and legs

Sequestration

Disc sequestration may be the result of an untreated or unnoticed disc extrusion. Here, your vertebrae compress the disc to the point of rupturing. A Sequestrated disc can cause intense pain and may lead to a loss of mobility, and also:

  • Numbness in the arms or legs
  • Difficulty walking
  • Tingling sensations in the arms or legs
  • Leg pain
  • Altered walking pattern

Treatment Options For A Herniated Disc

A herniated disc sounds like a harsh condition, but there are various treatment options.

Most of the time, a herniated disc improves over several days to weeks. These cases of herniation respond well to conservative treatments and don’t need to move to surgery.

Non-surgical Treatment

If you are not experiencing extreme signs of nerve compression or disability, conservative treatment is usually the first line of intervention. The goal of conservative or non-surgical treatment is to relieve your symptoms.

Medication

Anti-inflammatory medications such as ibuprofen and naproxen are commonly prescribed for mild to moderate pain. You can get these over-the-counter medications to reduce inflammation and relieve pain.

Your doctor may recommend steroid injections like cortisone for patients who have been experiencing pain for over 6 weeks. Steroid injections are delivered directly into the space around the nerve for almost immediate pain relief.

Physical Therapy

After a physical exam, your physical therapist devises a therapy plan specifically designed to treat herniated discs. The goal of the treatment is to help you regain your muscle strength and prevent re-injury.

Therapy may include strengthening exercises for your lower back, leg, and stomach muscles. You may also have to learn proper techniques for posture, walking, and lifting. Lastly, stretching exercises can improve the flexibility of your spine and legs.

Take plenty of rest and avoid strenuous movement in your daily activities. Non-surgical treatment of herniated disc may take between 4 to 8 weeks to reach pain-free and full activity.

If there is no significant improvement in your symptoms, then you can consider surgery for herniated disc.

Surgical Treatment

If pain medication and nonoperative treatment didn’t relieve your chronic pain, then your doctor may suggest invasive surgical intervention for your herniated disc.

Your pain is caused by too much force on your nerve roots. When we eliminate the pressure, we also eliminate the pain.

An orthopedic surgeon or neurosurgeon may perform disc surgery to relieve the pressure or compression of an intervertebral disc on a nerve root. There are different surgical techniques to achieve this:

  • Open Discectomy

In an open discectomy, your surgeon creates an incision in the midline of your lower back to expose your nerve roots and remove the herniated disc. During this open back surgery, your surgeon may also remove any bone spurs, bony projections that may cause joint damage.

Open discectomy has a high success rate and is highly recommended for treating patients with lumbar disc herniation.

Also called endoscopic spine surgery, microdiscectomy is essentially a minimally invasive form of open discectomy. It only needs a tiny incision, 1.5 inches or smaller, to remove the herniated disc.

A long thin tube called an endoscope allows better visualization of your nerve roots and surrounding tissues. Microdiscectomy is often the preferred procedure because it leads to less tissue damage, less blood loss, and less risk of infection. Not to mention a smaller scar.

  • Spinal disc core surgery

In spinal disc core surgery, your surgeon addresses the herniation from the core of the intervertebral disc. They make an incision in your back to access the affected disc and remove the disc’s center using a vacuum.

It leads to your intervertebral disc becoming smaller, which puts less pressure on your nerves. Disc core surgery is only recommended if the outer layer of your disc has not yet been damaged.

  • Laminectomy

Laminectomy is a common surgery used to manage disc herniation, particularly in the back and neck. In a laminectomy, an incision is made in the midline of your back to remove the whole or a part of the vertebra (spine bone) called the lamina. It helps remove the pressure on your nerve roots and spinal cord and decompress them.

After the lamina is removed, your surgeon can perform a discectomy to remove the herniated disc. Laminectomy helps relieve leg pain or other symptoms of disc herniation.

Spinal fusion helps in stabilizing the spine, especially after procedures like laminectomy. After a discectomy, your surgeon can join two or more of your vertebrae together using screws or rods. Over time your vertebrae grow and fuse to form a solid, stable structure.

This procedure is usually performed on patients with lumbar degenerative disc disease, deteriorating discs causing pain in the lower back. Recovery can take up to 1 year, and there’s a risk of limited spinal movement.

  • Artificial Disc Surgery

An alternative to spinal fusion is artificial disc surgery (ADS). Your surgeon removes the herniated disc and replaces it with an artificial disc.

Compared to spinal fusion, ADS provides more spine mobility, less stress on adjacent discs, and a quicker recovery period.

Should I Have Surgery For A Herniated Disc?

For most people, symptoms of a herniated disc resolve with conservative treatment or without treatment at all. Many who experience disc herniation can manage the symptoms through a conservative approach, such as medications, physical therapy, or steroid injections.

When these treatments fail, your doctor may recommend a surgical procedure to relieve your pain and prevent further damage.

With the advancements in medicine, surgery has become the go-to procedure for better short-term and long-term effects. Various surgeries for disc herniation have been proven safe and effective for treating chronic back and neck pain.

The success rate of disc herniation surgeries has also been growing over the years. A study reported a 94% long-term success rate for disc herniation surgeries in the neck and a 78.9% success rate for herniation surgeries in the lower back.

Who Needs Surgery for a Herniated Disc?

If you’re unsure if your condition needs surgery, here are a few factors that help surgeons determine whether they should perform surgery for slipped disc:

  • Persistent pain that didn’t respond to conservative management after 4-8 weeks
  • Weakness of the lower limbs affecting movement, whether standing or walking
  • Severe pain is making daily activities challenging
  • Severe numbness or tingling sensation in the upper or lower limbs
  • Inability to control the bladder or bowels

Your doctor may suggest surgery depending on the extent of your disability and the intensity of your pain. If you are experiencing some of the symptoms listed above, surgical treatment is highly recommended.

Benefits Of Surgery

Surgery provides a solution to a disc herniation that fails to respond to conservative management. Various surgical procedures for a herniated disc directly address the cause of your pain symptoms.

  • Faster pain relief: Most of the time, the full effects of conservative treatment are felt after a few weeks to months. Herniated disc surgery can provide rapid pain relief by directly removing the intense pressure on your nerves.
  • Lasting effects: Disc surgery involves completely removing the herniated disc, relieving the compression on your nerves. Researchers report that the chances of having little to no symptoms of a herniated disc are higher after surgical treatment.
  • Improved mobility: When the herniated disc is surgically removed, the vertebrae in your spine allow better movement. Everyday motions like bending, stretching, and lifting become easier.
  • Faster recovery: Patients who undergo surgery for a herniated disc earlier on experience a quicker recovery period and gain improved mobility within a few weeks.

For severe cases of disc herniation, surgical procedures may be the only option when your symptoms are so severe that it’s causing unbearable pain or issues with bladder or bowel functions.

Given the high success rate of lumbar disc herniation surgeries, it has become more beneficial for a lasting solution to lumbar disc herniation.

Outcomes of Treatment

Non-surgical Treatment

Non-surgical interventions are often effective treatments for reducing the pain and discomfort caused by a disc herniation. With consistent treatment, your symptoms may subside within 6 weeks. However, in many cases, conservative treatment might fail.

Surgical Treatment

Various types of surgeries can be performed for a slipped disc. These surgeries often provide more remarkable, long-term effects. You may experience a significant decrease in your pain and a great improvement in your physical function.

Remember, the longer you wait, the more challenging it will be on your road to recovery. If you’re in pain and not living a hundred percent, consult your doctor about your treatment options and what’s best for you.

FAQs

Do herniated discs go on their own?

Most mild cases of herniated discs resolve on their own. However, it is better to consult a neurosurgeon or an orthopedist to stop your condition from developing into something worse.

How painful can herniated discs be?

The symptoms differ for different people, from no pain to extreme pain.

What results in a herniated disc?

Different factors, from age to degeneration, strains, and injuries to the back. Sometimes, the cause is unknown.

Are there quick fixes to a herniated disc?

There is no quick treatment for slipped disc. If you have mild disc herniation, then symptoms might become better alone in a few days or weeks. More severe disc slippage usually needs treatment, and can take several weeks to recover from. Surgery, though, often offers fast relief compared to other treatments.

Can a herniated disc make you paralyzed?

Depending on the severity of the disc herniation. It can be severe enough to cause paralysis due to degeneration of your nerves.

Should I have surgery for a herniated disc?

After a six-week non-surgical treatment without any improvement in symptoms, surgery may be a good option for the treatment of disc herniation.

What will epidural steroid injections do to my herniated disc?

An injection of steroid medicine into your spinal space is called an epidural injection. It can help to relieve swelling or inflammation, helping you move more better or easing your pain.

How should I sleep when I have a herniated disc?

Sleeping when you have a herniated disc should be done in a position that doesn't cause nerve compression due to the herniation. Sleeping on your back can be helpful in this context.

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About the Author:
Dr. Mersad is a medical doctor, author, and editor based in Germany. He's managed to publish several research papers early in his career. He is passionate about spreading medical knowledge. Thus, he spends a big portion of his time writing educational articles for everyone to learn.

Sources

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