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Decision focus: surgery for herniated disc

By Nancy Reid, Staff Writer, myOptumHealth

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Most people have back pain once in a while, perhaps after a heroic landscaping project or a lively company softball game. The pain fades quickly along with your memory of it. But if you have ever had a herniated disc (commonly called a slipped disc), you can probably recall the excruciating pain at once.

Surgery was once a first-line treatment for herniated disc. But recent studies show that conservative treatment, including a limited rest period, medications and physical therapy, works for most people. 

What is a herniated disc?

Like shock absorbers, your spinal discs cushion the motion between the bones of your spine (vertebrae). The discs are made of soft and spongy material and have a tough outer layer. A herniated disc occurs when the disc is damaged and bulges or breaks through the outer layer. The bulge can put pressure on the spinal cord or a spinal nerve, causing pain and muscle weakness. Aching pain in buttocks, thigh, leg or foot, called "sciatica," is a common symptom.

Your treatment options

You may have several options for treating your herniated disc, including:

• Try a nonsurgical approach. In nine out of 10 cases, herniated discs get better within six weeks without surgery. Doctors usually suggest that you rest initially, take pain medications and try physical therapy, massage and other self-care measures.
• Wait and see. Most experts advise conservative therapy for at least six to 12 weeks before deciding on surgery for a herniated disc. If your back pain lessens each day, you might decide to forego surgery all together. If your back pain persists and is unbearable, you might decide to have surgery.
• Have surgery. Some people require surgery to relieve pain, especially when the herniated disc is severe or leg pain is the main symptom.

The most common surgery for a herniated disc is called a discectomy. This is the surgical removal of a herniated disc so that it no longer presses on the nerve root or the spinal cord. One type of discectomy that is becoming more available is a microdiscectomy. The surgeon uses an examining microscope to make tiny incisions and remove a small amount of tissue. There is less damage to surrounding tissue and a quicker healing time compared to other procedures.

Experts advise that you get a second opinion (if possible) when surgery is recommended. Find a surgeon with lots of experience.

Pros and cons

It's important to weigh the risks and benefits of your options before making a decision to have surgery.

Surgery

Pros of surgery

• You may get relief right away with surgery.
• On occasion, surgery is needed to take pressure off the spinal cord or nerves to prevent permanent damage.

Cons of surgery

• Most of the time surgery is not needed. Nine out of 10 people with herniated discs heal on their own.
• Surgery requires some recovery time. Most doctors also recommend physical therapy after surgery.
• Pain relief may be short-lived. As early as six months after surgery, you may start having pain again.
• Surgery has risks, including bleeding, infection or injury to the spine. These risks are rare.

A NOTE OF CAUTION:

A herniated disc can be dangerous in rare cases. Seek emergency medical care if you have back pain along with any of the following:

• Tingling, weakness or numbness
• Pain down the leg
• Trouble walking
• Loss of bladder or bowel control
• Nausea, vomiting, fever, chills
• Severe pain after injury, such as in a fall or automobile accident

View the original Decision focus: surgery for herniated disc article on myOptumHealth.com 

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