What is a herniated disc?
The bones that form the
spine in your back are cushioned by discs. Spinal discs are round and flat,
with a tough, outer layer (capsule or annulus) that surrounds a jellylike
material (nucleus). When these discs are healthy, they act as shock absorbers
for the spine and keep the spine flexible. When they are damaged from an
injury, normal wear and tear, or disease, they may bulge abnormally or break
open (rupture). An abnormally bulging or ruptured disc is called a
herniated disc, or sometimes a slipped disc.
See a picture of a
herniated disc .
A bulging or herniated
disc may press on a nerve where the nerve branches off from the spinal cord in
your back. This pressure can cause pain, numbness, tingling, weakness, or loss
of reflexes in the leg. It may or may not cause lower back pain. But many
herniated discs don't cause any symptoms. If an
MRI scan shows that you have a herniated disc, your
doctor will carefully compare the results of the MRI with your symptoms and the
results of your physical exam to be sure that the herniated disc seen on the
MRI is the likely cause of your symptoms.
When is nonsurgical treatment used to treat a herniated disc?
Most herniated discs heal after a few months of nonsurgical
treatment. Nonsurgical treatment may include a short period of rest, medicine
for pain relief, and a
physical therapy and exercise program prescribed by a
doctor. About 50% of people with a herniated disc in the low back recover
within 1 month. And within 6 months, most people recover. Only 10% of people
with herniated disc problems that cause noticeable symptoms eventually have
If you are getting better
after 6 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 relieves the pain and other symptoms caused by pressure on the
nerve. This process is called
When is surgery for a herniated disc recommended?
Surgery is eventually considered for about 10% of people who have a
herniated disc.2 Most doctors will wait to consider
surgery after you have tried nonsurgical treatment for 1 to 3 months without
improvement (but usually before more than 6 months have gone by). People who
have had a herniated disc that causes constant pain, weakness, or numbness for
longer than 6 months may have permanent nerve damage and may benefit less from
Surgery to treat a herniated disc is done to reduce pain
and allow for more normal movement and function. It is considered if the
following conditions are present:3
- You have a history of persistent leg pain
that has not improved with at least 4 weeks of nonsurgical treatment, as well
as weakness and limitation of daily activities. If you have these symptoms, see
the Interactive Tool: Low Back Surgery Tool to see whether
surgery might help.
- Results of a physical examination finds that
you currently have weakness, loss of motion, abnormal sensitivity, or positive
- Diagnostic testing,
such as magnetic resonance imaging (MRI), computed tomography, or myelogram,
indicates that your herniated disc can be treated surgically.
Disc surgery can be used to treat:
ruptured disc or free fragments of disc material that
are clearly the cause of nerve root compression. If severe and disabling
sciatica pain fails to improve after at least 4 to 6 weeks of nonsurgical
treatment, your doctor may recommend surgery.
- A bulging or ruptured
disc that is causing serious nerve damage. Common signs of nerve damage are
felt in the leg, and include weakness, loss of coordination, or loss of
- A structural bone problem that can only be treated with
surgery (in this case, nonsurgical treatment would be
Cauda equina syndrome.
What kinds of surgery are done for a herniated disc?
The most common and well-researched herniated disc surgeries are:
which is the surgical removal of herniated disc material that presses on a
nerve root or the spinal cord. It is also used for
bulging discs or
ruptured discs. Discectomy may be the most effective
type of surgery for people who have tried nonsurgical treatment without success
and who have severe, disabling pain.
Laminotomy and laminectomy, surgeries done to relieve pressure on the spinal cord
and/or spinal nerve roots caused by age-related changes in the spine.
Laminotomy removes a portion of the thin part of the vertebrae that forms a
protective arch over the spinal cord (lamina). Laminectomy removes all of the
lamina on selected vertebrae and also may remove thickened tissue that is
spinal canal , the opening in the vertebrae through which the spinal cord runs.
Either procedure may be done at the same time as a discectomy, or separately.
Percutaneous discectomy, which inserts a special tool
through a small incision in the back. Disc material is then removed or
destroyed to try to reduce pressure on the nerve root. Percutaneous discectomy
is considered less effective than open discectomy.4
What are the risks of herniated disc surgery?
Discectomy and microdiscectomy, the most common surgeries for herniated
discs, are generally well-tolerated and do not commonly cause complications.
But there is a slight risk of damaging the nerve roots or spinal structures
during surgery. Some people develop excessive scarring in the area of the
surgery. There is also some risk of infection following surgery, which may
cause further damage. An infection may require antibiotics and additional
All surgery involves some risk. Also, because there are
risks with general anesthesia, your doctor and medical staff will carefully
monitor you during your surgery and recovery.
How effective is herniated disc surgery?
with milder symptoms tend to do well without surgery. People with prolonged
symptoms that are severe enough to interfere with normal activities and work
and that require strong pain medicines may gain relief from surgery. A study
begun in 1990 followed about 500 people with low back pain caused by a
herniated disc. Some had surgery and some did not. Follow-up information was
gathered 5 years and 10 years after the beginning of the study.5, 1
- People with moderate to severe pain who had
surgery noticed a greater improvement than those who did not have surgery.
- Those who had surgery noted more relief from the symptoms they
considered most important than those who did not have surgery.
- At 5 years, 70% of those who had surgery
reported improvement in their most important symptom, compared with 56% of
those who received nonsurgical treatment.
- At 10 years, 71% of
people who had surgery were satisfied with their current situation, compared
with 56% of those treated nonsurgically.
- But the type of treatment did not make a
significant difference with regard to work and disability. The percent of
people working at the time of the 10-year follow-up was similar, regardless of
whether they had chosen surgical or nonsurgical treatment.
Some people elect to have surgery when work or life
responsibilities make a relatively quick recovery necessary. For nonphysical
work, you can expect to return to work in 2 to 4 weeks. For physically
demanding work, you will require 8 to 12 weeks.
Many people are
able to resume work and daily activities soon after surgery. In some cases,
your doctor may recommend a rehabilitation program after surgery, which might
physical therapy and home exercises.
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