When Do I Need Surgery for a Herniated Disk?

Disks are the round cushions that sit between the bones of your spine (vertebrae). They act like shock absorbers, and let you bend and move without your bones rubbing together.

When one of the disks ruptures (herniates) and pushes out from between the bones, it can press on nearby nerves. It can lead to pain, numbness, and weakness in your back, legs, and arms.

Often you can relieve a herniated disk with rest, pain relievers, and physical therapy. But if your symptoms don't get better after a few months, surgery may be an option. It can improve your pain faster than other treatments, but it can have side effects.

Do I Need Surgery?

Herniated disk surgery is an option if you're otherwise healthy but:

  • You feel so much pain that you can't get around or do your daily activities.
  • You have numbness or weakness from the disk pressing on nerves.
  • You can't control your bladder or bowels.
  • You have trouble standing or walking.

Surgeries for a Herniated Disk

Surgery should take the pressure off the nerves that are bothered by your herniated disk. There are a few different surgeries that can do this and relieve your pain.

Diskectomy. During this surgery, your surgeon removes your damaged disk to relieve pressure on your nerves. He can perform the surgery in a couple of ways:

  • An open diskectomy is done with a cut in your back or neck.
  • Microdiscectomy is done through a much smaller cut. Your surgeon inserts a thin tube with a camera on one end to see and remove the damaged disk.

Lumbar laminotomy. Sometimes your surgeon will also need to remove a small piece of bone called the lamina from the vertebra. The lamina forms a cover that protects your spinal cord. Removing part or all of it helps the surgeon get to your herniated disk. It also can relieve pressure on your nerves and stop leg pain and sciatica.

  • Laminotomy removes some of the lamina
  • Laminectomy removes most or all of the lamina

The lamina can be removed at the same time as the diskectomy. Or, you might have it taken out in a separate surgery.

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Spinal fusion. After a diskectomy or laminotomy, your surgeon may fuse together the two vertebrae on either side of the disk to make your spine more stable. This is called spinal fusion. Fusing the two disks will stop the bones from moving and prevent you from having any more pain.

Artificial disk surgery. Only a small number of people are able to get artificial disk surgery because it only works on a few disks in your lower back. But if your doctor thinks this is an option, he will replace your damaged disk with one made of plastic or metal. The new disk will help keep your spine stable, and let you move more easily.

What Can I Expect During Recovery?

Herniated disk surgery is often very effective, and it works faster than other treatments. You should start to see an improvement in symptoms like pain, weakness, and numbness within a few weeks after surgery.

Physical therapy or rehab can help you recover quicker. You can go to a rehab center, or do exercises at home. Walking can also help you regain movement in your spine.

In the first few weeks after your surgery, be careful not to:

  • Lift heavy objects
  • Sit for long periods of time
  • Bend or stretch too much

Your doctor will let you know when you can drive, go back to work, and do other things you usually do. You should be able to go back to a desk job in 2 to 4 weeks. If you have to lift heavy objects or work big machines at your job, you might have to wait 6 to 8 weeks.

What Are the Risks? What Is My Outlook?

Herniated disk surgery is very safe. Risks are rare, but can include:

  • Infection
  • Damage to nerves or blood vessels
  • Problems with the new disk
  • Leaks of spinal cord fluid
  • Bleeding

There's a small chance surgery won't improve your symptoms. Or, your pain might get better for a while and then come back in the future.

Surgery can give most people with a herniated disk relief from pain and other symptoms. Yet it doesn't work for everyone. In about 5% of cases, the disk will herniate again.

Although surgery offers faster relief than other treatments, it isn't always the best choice. Talk to your doctor carefully about the risks and the benefits of surgery before you decide on a treatment.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 9, 2016

Sources

SOURCES:

American Academy of Orthopaedic Surgeons: "Herniated Disk in the Lower Back."

American Association of Neurological Surgeons: "Herniated Disk."

New York University Langone Medical Center: "Surgery for Herniated Disk."

North American Spine Society: "Artificial Disk Replacement." "Open Diskectomy."

Northwestern Medicine: "Herniated Disk Treatments."

Temple University Hospital: "Herniated Disk Surgery."

University of Michigan Health System: "Lumbar Herniated Disk: Should I Have Surgery?"

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