Not everyone needs surgery for a herniated disc. People who are able to cope with the pain may be able to hold on until the condition gets better. But for those who can’t wait for the slow improvement, surgery is a sensible choice.
Sometimes the decision is made based on the patient’s needs. For example, if physical activity or work is affected too much, surgery may be very valuable. But more and more studies are showing that if a patient can wait it out, their symptoms will gradually get better and go away. It may take three to six months. But the natural course of herniated disc is one of slow recovery.
In fact, spine surgeons are finding that one-year after the start of painful symptoms, patients have the same result whether they have surgery or opt for nonsurgical care. Up until the late 1990s, the rate of disc surgery was the highest it’s ever been. Since then, the guidelines have changed.
The timing for disc surgery is now suggested only for patients with severe sciatica. This is especially true for those who have not gotten relief from symptoms after six months or more. Microdiscectomy can still be done after months of severe, disabling back and leg pain. Patients who delay surgery have just as good of results. This is the case when compared to patients who have surgery within the first two weeks of symptoms.
The bottom-line is that the window of opportunity for surgical intervention is much more wide open than previously believed. The results of studies suggest that patients should be given enough information to make informed decisions about treatment. Severity of symptoms, patient values and expectations, and personal circumstances will guide those decisions.