When Does Someone Know They Need Surgery for a Herniated Disc?
A herniated disc, also known as a slipped or ruptured disc, occurs when the soft inner gel of a spinal disc protrudes through a tear in the tougher outer layer. This condition can cause significant pain, numbness, and weakness, often affecting the lower back or neck. While many cases of herniated discs can be managed with conservative treatments such as physical therapy, medications, and lifestyle modifications, there are instances where surgery becomes necessary.
Understanding Conservative Treatments
Before considering surgery, most doctors recommend a variety of non-surgical treatments. These may include:
- Physical Therapy: Exercises and stretches designed to strengthen the muscles around the spine, improve flexibility, and reduce pressure on the affected disc.
- Medications: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. In some cases, doctors may prescribe stronger medications, including muscle relaxants or narcotics.
- Epidural Steroid Injections: These can help reduce inflammation and pain around the affected nerve.
- Lifestyle Changes: Maintaining a healthy weight, avoiding activities that exacerbate the pain, and practicing good posture can all contribute to relief.
When to Consider Surgery
Surgery for a herniated disc is typically considered when conservative treatments have failed to provide relief after six weeks to three months. Several specific conditions and symptoms can indicate the need for surgical intervention:
- Severe Pain: If the pain from a herniated disc is severe and persistent, and does not respond to non-surgical treatments, surgery may be necessary to relieve the pressure on the affected nerve.
- Neurological Symptoms: Progressive neurological symptoms such as numbness, tingling, or weakness in the arms or legs, particularly if they worsen over time, may indicate nerve damage. Surgery can help prevent further deterioration.
- Loss of Bladder or Bowel Control: A rare but serious condition called cauda equina syndrome can occur when a herniated disc compresses the nerves at the lower end of the spinal cord. This can lead to loss of bladder or bowel control and requires immediate surgical intervention.
- Difficulty Standing or Walking: If a herniated disc causes significant weakness in the legs, making it difficult to stand or walk, surgery might be needed to restore function.
Types of Surgical Procedures
Several surgical options are available for treating a herniated disc. The choice of procedure depends on the location of the herniation, the patient’s overall health, and the severity of symptoms. Common surgical procedures include:
- Microdiscectomy: This minimally invasive procedure involves removing the portion of the herniated disc that is compressing the nerve. It is often recommended for patients with leg pain (sciatica) caused by lumbar disc herniation.
- Laminectomy: In this procedure, a portion of the vertebral bone called the lamina is removed to create more space for the nerves. It is typically used for cases involving significant spinal stenosis.
- Disc Replacement: In some cases, the damaged disc is replaced with an artificial one. This procedure is more common in younger patients with a single-level disc herniation.
- Spinal Fusion: This involves fusing two or more vertebrae together to stabilize the spine. It is generally considered when there is instability or when other procedures are not suitable.
Recovery and Outlook
Recovery from herniated disc surgery varies depending on the specific procedure and individual patient factors. Most patients experience significant pain relief and improved function following surgery. Physical therapy and lifestyle modifications are often recommended post-surgery to support recovery and prevent recurrence.
While conservative treatments are effective for many individuals with a herniated disc, surgery may be necessary for those with severe, persistent symptoms or neurological complications. Early intervention and a comprehensive treatment plan are key to achieving the best possible outcomes.
The contents of this article have been reviewed by Dr. Michael Spadola, a Penn Medicine neurosurgeon.
Dr. Spadola treats patients at Shore Physicians Group’s Neurosurgery Division office located at 155 Medical Center Way in Somers Point, NJ. To schedule an appointment with Dr. Spadola, call 609-365-6239.
