Decision Focus: Surgery for Herniated Disc
Herniated disc is a common cause of back pain. This article details the pros and cons of your treatment choices.

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myoh_surgeryherndisc.giv Decision Focus: Surgery for Herniated Disc

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, and so does 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, 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. Sciatica, an aching pain in the buttocks, thigh, leg or foot, is a common symptom.

Your treatment options
You may have several options for treating your herniated disc.

Try a nonsurgical approach. In 9 out of 10 cases, herniated discs get better within 6 weeks without surgery. Doctors usually suggest 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 6 to 12 weeks before deciding on surgery for a herniated disc. If your back pain lessens each day, you might decide to skip 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. This results in less damage to surrounding tissue and a quicker healing time compared to other procedures.

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

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

Pros:

  • 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:

  • Most of the time surgery is not needed. About 9 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. You may start having pain again as soon as 6 months after surgery.
  • Surgery has risks, including bleeding, infection and 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:

  • Sudden severe tingling, weakness or numbness
  • Sudden trouble walking
  • Sudden loss of bladder or bowel control
  • Nausea, vomiting, fever, chills
  • Severe pain after injury, such as a fall or an automobile accident
By Nancy Reid, Contributing Writer
Created on 08/16/2009
Updated on 08/14/2012
Sources:
  • Institute for Clinical Systems Improvement. Low back pain, adult (guideline).
  • North American Spine Society. Herniated lumbar disc.
  • Jordan J, Konstantinou K, O'Dowd J. Herniated lumbar disc. Clinical Evidence. 2009;03:1118.
  • Carragee E. Surgical treatment of lumbar disk disorders. Journal of the American Medical Association. 2006;296(20):2485-2487.
Copyright © OptumHealth.
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