How Bad Does a Herniated Disc Have to Be for Surgery?

Reviewed on 5/10/2021

A herniated disc (bulged, slipped, or ruptured disc) affects the discs in the back that cushion the bones (vertebrae) of the spine, and is common in the lower back (lumbar spine). Surgery for a herniated disc is not always necessary, but it can speed up recovery time, which can take several months.
A herniated disc (bulged, slipped, or ruptured disc) affects the discs in the back that cushion the bones (vertebrae) of the spine, and is common in the lower back (lumbar spine). Surgery for a herniated disc is not always necessary, but it can speed up recovery time, which can take several months.

A herniated disc (also called a bulged, slipped, or ruptured disc) affects the discs in the back that cushion the bones (vertebrae) of the spine. The discs serve as shock absorbers for the vertebrae. When part of the jelly-like center of a disc is pushed out of the tough, outer layer into the spinal canal, this is considered a herniated disc. 

Herniated discs are most common in the lower back (lumbar spine), but they can occur in any part of the spine.

Surgery for a herniated disc is not usually necessary because over time the body will absorb the jelly from the damaged disc and heal on its own. However, this recovery process can take months. Surgery can relieve pain and speed up recovery time. 

A herniated disc doesn’t necessarily have to be bad in order to have surgery. Surgery may be considered for herniated disc if:

  • Symptoms last at least 6 weeks, conservative treatments have not helped, and a person has difficulty with normal activities
  • A patient needs to get better quickly because of their job or a need to get back to other activities as soon as possible
  • Leg weakness is getting worse

Both surgical and nonsurgical treatments are equally effective in reducing pain and other symptoms. The main difference is generally recovery time. 

What Are Symptoms of a Herniated Disc?

A herniated disc does not always cause symptoms. When symptoms occur, they can depend on which disc is affected and how large the herniation is, and may include: 

  • Low back pain
  • Herniated disc in the lower back (lumbar spine)
    • Tingling, pain, burning, numbness, or weakness that spreads down one leg and sometimes into the foot 
      • Usually only one side is affected
      • Pain may be described as sharp and electric shock-like
      • Straightening the leg can worsen the pain
      • Pain may be more severe when standing, sitting, or walking
    • Sciatica/radiculopathy 
  • Herniated disc in the neck (cervical spine) 
    • Dull or sharp pain in the neck or between the shoulder blades
    • Pain that radiates down the arm to the hand or fingers 
    • Numbness or tingling in the shoulder or arm
    • Pain may increase with certain positions or movements of the neck

What Causes a Herniated Disc?

In some cases, excessive strain or injury may cause a herniated disc, but the main cause of a herniated disc is natural degeneration that occurs with aging. In some people even a minor strain or twisting movement can cause a disc to rupture. 

Some people are predisposed to disc problems and herniated discs may run in families.

QUESTION

Nearly everyone has low back pain at some time during their life. See Answer

How Is a Herniated Disc Diagnosed?

In general, a patient history and physical examination is all that is needed to diagnose a herniated disc because most people who have symptoms of a herniated disc will recover on their own. 

Doctors will usually wait until a person has symptoms for at least 4 to 6 weeks before ordering tests. The reason for this is that the treatment is the same, no matter what the test might show. In cases where tests are needed, they may include imaging tests such as: 

What Is the Treatment for a Herniated Disc?

Herniated discs often go away on their own and conservative treatment may be all that is needed. 

Conservative treatments include:

  • Over-the-counter pain medications 
  • Muscle relaxants
  • Injections of medicines that numb the back 
  • Steroid injections
  • Physical therapy to learn strength and stretching exercises
  • Spinal manipulation by a physical therapist or a chiropractor 
  • Acupuncture
  • Massage
  • Exercise and staying active
    • Bed rest can make problems worse because the back can become stiff and weak
    • Take short walks for 10 to 20 minutes on flat surfaces (avoid hills or stairs when possible)
    • Patients may need to change the way they move when performing activities so they do not cause or worsen symptoms 

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Reviewed on 5/10/2021
References
https://www.uptodate.com/contents/herniated-disc-the-basics?search=Herniated%20Disc%20&source=search_result&selectedTitle=1~107&usage_type=default&display_rank=1

https://www.uofmhealth.org/health-library/aa6282

https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc