How can you decide about surgery for a herniated disc?

What kinds of surgery are done for a herniated disc?

There are different ways to remove disc material. They are:

• Open discectomy. This is done through a large cut in your back. The cut is called an incision.
• Microdiscectomy. This is done through a smaller incision. It causes less damage to the tissue around it.
• Minimally invasive procedures. These are done through one or more tiny incisions in your back. Your doctor can put special tools through the incisions, such as cutting or heating devices or lasers. These tools can cut or destroy part of the disc.

In some cases, a small piece of bone from the affected vertebra may be removed. This small piece is called the lamina. It's the thin part of the vertebrae that forms a protective arch over the spinal cord. A procedure called a laminotomy removes some of the lamina. A laminectomy removes most of or all of the lamina. It also may remove thickened tissue that narrows the spinal canal. Either of these procedures may be done at the same time as a discectomy. Or they can be done separately.

What are key points about this decision?

• A herniated disc in the lower back is a common cause of back and leg pain. For most people, symptoms get better over time, with or without treatment.
• Many people are able to manage their symptoms with things like changes in the way they do their activities, medicines to manage pain, exercise, physiotherapy, and steroid injections. If one of these things doesn't work, you can try something else. Or you can combine some of them.
• Surgery may relieve your pain faster than non-surgical treatments. For symptoms that have lasted at least 6 weeks and that make it hard to do your normal activities, surgery is an option when other treatments haven't helped.
• Over the long term, surgery and non-surgical treatments work about the same to reduce pain and other symptoms.
• Back surgery has some risks. These include infection, nerve damage, and the chance that the surgery won't relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.
• If you don't choose surgery now, you can change your mind later if your symptoms haven't gotten better or have gotten worse even with other treatments.

Why might you choose surgery?

• Surgery works well for many people who have sciatica from a herniated disc.
• Surgery offers faster pain relief than other treatment.
• You have tried exercises and medicines for at least 6 weeks. You don't think they have helped you.
• You feel okay about the idea of having back surgery.

Why might you choose not to have surgery?

• Treatments without surgery work for most people.
• In the long term, people who don't have surgery are just about as likely to be able to do their daily activities as people who do have surgery.
• You don't like the thought of surgery.
• Your pain isn't bad enough that you need to have surgery right now.

Your decision

Thinking about the facts and your feelings can help you make a decision that is right for you. Be sure you understand the benefits and risks of your options, and think about what else you need to do before you make the decision.