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"Just the Facts" on Treating Herniated Discs

Many adults hurt their backs and need surgery to repair a protruding, or herniated, disc. The disc is a jelly-like cushion between each bone of the spine. When a disc is herniated, there is often low back pain and pain that travels down the leg. The pressure of the disc on the spinal nerve can cause muscle weakness and loss of sensation in the leg.

Treatment for disc problems can be with or without surgery. This is usually based on the size of the disc protrusion, the size and shape of the opening for the spinal cord (spinal canal), and the patient's symptoms. So how do you know when to have surgery for disc herniation?

Fact: The first surgery for low back disc herniation took place more than 60 years ago. Though many years have passed, no single treatment program has been set for all disc problems.

Fact: Surgery is usually advised for large herniations.

Fact: Only 25 percent of people who try treatment without surgery end up having surgery later.

Fact: Patients who have the disc removed (discectomy) have better results at one year than those who don't.

Fact: There is no difference in the results of those who are operated on and those who aren't 10 years later.

Fact: In some cases, the body absorbs disc material that has moved into the spinal canal. Doctors aren't sure how the body does this, or why it happens for some patients.

There are guidelines for the treatment of low back problems in adults. These are put out by the U. S. Department of Health and Human Services. The guidelines urge a shared decision-making process between doctor and patient. This means there is no single recommendation for all patients. Each case must be evaluated on an individual basis. The doctor is the best one to advise when to use a "wait and see approach" and when to have surgery.

References: Alex Reyentovich, BS, and William A. Abdu, MD, MS. Multiple, Independent, Sequential, and Spontaneously Resolving Lumbar Intervertebral Disc Herniations. In Spine. March 1, 2002. Vol. 27. No. 5. Pp. 549-553.

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