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Should I Get Surgery for My Disc Herniation?

Should I Get Surgery for My Disc Herniation?
March 23, 2016 Dr. Phillip Snell

Is Disc Surgery the Best Option?

should-i-get-surgery-for-my-disc-herniationA common misconception in many patients is that the preferred treatment for lumbar disc herniation is surgery. Many people think that once a disk has herniated, the extruded portions must be surgically removed or they will always provide pressure on nerve roots. You can see the previous article “Will My Disc Herniation Ever Heal?” on this blog for a more detailed exploration of that topic. For now, it’s important to know that disc herniations heal and extruded fragments of disc material are resorbed by the body over time. The question of whether surgery to manage a lumbar disc herniation is superior to conservative care is a bit more of a gray area. Several large studies have been performed investigating surgical versus nonsurgical interventions for lumbar disc herniation and results have been mixed. Review studies examining the breadth of the literature on the topic generally point out that for those with leg pain (sciatica) due to disc herniation, surgery will quickly help with the leg pain and with pain in the back.(1,2,3)  When patients in surgical and conservative care groups are tracked over 1-2 years, the results are similar. So, does that mean that surgery is the best route to go? To answer that question we need to consider the risks associated with both surgical and nonsurgical interventions.

Risk of complications with conservative interventions is exceedingly small. However, with the prospect of quicker relief of pain, some might say the surgery is an easy choice. With surgical intervention, risk of post-operative infection is a growing concern as more antibiotic-resistant pathogens are noted in medical facilities.(4) Risk of recurrence of disc herniation after surgery is also a concern. (5) Some folks feel that the clock is ticking after their injury and that if they wait too long, they might lose the benefit of the surgery. A February 2016 study out of Scotland shed more light on that question. The researchers looked at people who had failed conservative care for lumbar disc herniation and sciatica and had opted for microdiscectomy surgery. They divided them into 4 groups: those whose symptoms were <6 months old, those whose symptom onset was between  6-12 months old, those with symptom onset between 1-2 years prior and those that had symptoms more than 2 years. They found that the benefit from surgery across all groups was similar in terms of pain reduction and improvement in function. (6)

The “elephant in the room” with either surgical or non-surgical intervention is whether the patient understands the cause of the injury and can avoid repeating the injury. Our focus here on FixYourOwnBack is to improve understanding of the mechanism of lumbar disc injury and how to reduce risk of re-injury while improving function. More often than not, simple self-help hacks like McKenzie Exercises can help you control the pain while your body resorbs the disc. Even if a person decides to opt for the surgical route, the information and exercise suggestions on this site might contribute to reduce future risk of injury.

References

1. Lurie JD, Tosteson TD, Tosteson AN, Zhao W, Morgan TS, Abdu WA, Herkowitz H, Weinstein JN. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976). 2014 Jan 1;39(1):3-16.

2. Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW; Leiden-The Hague Spine Intervention Prognostic Study Group. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007 May 31;356(22):2245-56.

3. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005 Apr 15;30(8):927-35.

4. http://www.theatlantic.com/health/archive/2015/10/how-antibiotic-resistance-could-make-common-surgeries-more-dangerous/410782/

5. Watters WC 3rd, McGirt MJ. An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J. 2009 Mar;9(3):240-57.

6. Pitsika M, Thomas E, Shaheen S, Sharma H. Does the duration of symptoms influence outcome in patients with sciatica undergoing micro-discectomy and decompressions? Spine J. 2016 Feb 29.