If you have a herniated disc, your symptoms may improve without surgery. But by how much? And by when? It’s possible to wait it out, and let nature takes its course by shrinking your disc and resorbing the herniated material. This process takes about a year and may require a lot of work on your part. Compare that to a successful back surgery, which may relieve your pain soon after the procedure is done.
If symptoms continue to interfere with your daily activities after you’ve tried conservative care for 6 weeks, your doctor may suggest surgery.
In many cases, a herniated disk is related to the natural aging of your spine.
In children and young adults, disks have a high water content. As we get older, our disks begin to dry out and weaken. The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process is called disk degeneration.
Risk Factors
In addition to the gradual wear and tear that comes with aging, other factors can increase the likelihood of a herniated disk. Knowing what puts you at risk for a herniated disk can help you prevent further problems.
Gender. Men between the ages of 30 and 50 are most likely to have a herniated disk.
Improper lifting. Using your back muscles to lift heavy objects, instead of your legs, can cause a herniated disk. Twisting while you lift can also make your back vulnerable. Lifting with your legs, not your back, may protect your spine.
Weight. Being overweight puts added stress on the disks in your lower back.
Repetitive activities that strain your spine. Many jobs are physically demanding. Some require constant lifting, pulling, bending, or twisting. Using safe lifting and movement techniques can help protect your back.
Frequent driving. Staying seated for long periods, plus the vibration from the car engine, can put pressure on your spine and disks.
Sedentary lifestyle. Regular exercise is important in preventing many medical conditions, including a herniated disk.
Smoking. It is believed that smoking lessens oxygen supply to the disk and causes more rapid degeneration.
For most people with a herniated disk, low back pain is the initial symptom. This pain may last for a few days, then improve. It is often followed by the eventual onset of leg pain, numbness, or weakness. This leg pain typically extends below the knee, and often into the foot and ankle. It is described as moving from the back or buttock down the leg into the foot.
Symptoms
Symptoms may be one or all of the following:
- Back pain
- Leg and/or foot pain (sciatica)
- Numbness or a tingling sensation in the leg and/or foot
- Weakness in the leg and /or foot
- Loss of bladder or bowel control (extremely rare) This may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.
Not all patients will experience pain as a disk degenerates. It remains a great challenge for the doctor to determine whether a disk that is wearing out is the source of a patient's pain.
Discectomy involves removing fragments of the disc that press on and irritate the spinal nerve root. Discectomy is the most common surgery performed for a low back disc herniation. It has about an 80% to 90% success rate for relieving radicular symptomssuch as sciatica, numbness, weakness and/or pain down one leg.
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Discectomies may be full operations (called “open discectomies”) or they may be minimally invasive procedures. Due to technological advances in medical/surgical techniques, devices and equipment, the trend in surgery is toward the minimally invasive. Two types of minimally invasive procedures are the microdiscectomy and percutaneous arthroscopic discectomy.
If you are deciding which kind of discectomy to have, consider the skill set of your potential surgeon. Some doctors may insist on performing an open discectomy because they haven’t been thoroughly training in the minimally invasive types. Others may specialize in one type of procedure over the other. Check your doctor’s competencies and compare them with those of other surgeons before deciding who will perform the procedure.
Spinal fusion involves removing the disc and fusing the adjacent bones together. If you have instability in your spine or you’ve already had one or more discectomies, you may need a spinal fusion. Spinal fusion may require that hardware, such as plates and screws, be installed. It may also involve a bone graft. Doctors only rarely perform spinal fusions with microdiscectomies.
Surgery for herniated lumbar disc generally relieves leg pain with great success. It is less effective for relieving back pain, though. (Exercise often is the best way to manage back pain.) Along with leg pain relief, surgery may help stop your leg from getting weaker.
Speak with your doctor about the appropriateness of surgery for your herniated disc if you are unsure which treatment is right for you.
The results of microdiskectomy surgery are generally very good. The outcome of leg pain improvement is much more reliable than back pain and therefore this surgery is rarey performed for back pain only.
Most patients notice improvement over the first several weeks following surgery, but may also experience continued improvement over several months. Pain is typically the first symptom to improve, followed by improvement in overall strength of the leg, and then sensation. It is common for some patients to state that although pain symptoms are better, they still have a numb spot on their leg or foot.
Most patients will slowly resume normal daily activities over the first several weeks following surgery.
Over the last several years, there has been extensive research on lumbar disk surgery and patient improvement. One of the most publicized research projects in this area is the Spinal Patient Outcomes Research Trial (SPORT). The study followed patients with herniated disk from across the country. Half were treated with conservative measures, and half with surgery.
The initial outcomes for patients treated with surgery were much better than those who followed conservative treatment, including improvement in pain relief and function. At the 2-year follow-up, patients treated with surgery again showed improvements over those treated conservatively. However, over the course of the study, numerous patients did change their treatments. Your surgeon will be best able to explain what the actual study results are with any recommended approach for you.
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