When You Need Surgery for a Herniated Disc (And When You Don’t)

Choosing the Right Path for Your Recovery

I get a lot of questions from patients about their treatment options when they are dealing with a herniated disc. Usually, they fall into two camps: some are in so much pain that they want to know if surgery can fix it immediately, while others are scared of spine surgery and hope they can avoid that route entirely. Both reactions are completely normal. When you’re dealing with a "lightning bolt" of leg pain or a back that feels completely locked up, you just want a clear answer on how to get your life back.

I wanted to write this blog to give you more information about when you need surgery for a herniated disc and when you don't. The truth is that different approaches are right for different people. There is no exact timeline because every patient has a different lifestyle and different goals for their recovery. Either way, our goal is the same: to relieve pressure on the spinal nerve and get you moving again.

What to Expect If Surgery Is the Right Fit

When I talk to patients about surgery for a herniated disc, I want to provide a realistic idea of what that looks like. I typically recommend surgery if the pain in your leg is so intense that you have trouble standing, sitting, or sleeping, and other treatments haven't provided pain relief.

The goal of modern disc surgery is to get you back to your normal activities quickly. Most herniated disc surgery today is performed using minimally invasive techniques. As an orthopedic surgeon, I prefer these methods because they allow me to work through a small incision or tiny incisions rather than the large incision used in traditional back surgery.

During a minimally invasive discectomy, the surgeon removes the herniated part of the disc that is pressing on the nearby nerves. By using a microscope and specialized tools, the surgeon makes a path to the affected area without having to disrupt the surrounding muscles. This is usually done under general anesthesia, and most patients head home from the recovery room the same day. You can expect the leg pain to quiet down almost immediately, though it often takes a few weeks for the nerve to fully heal.

The Threshold of Clinical Necessity

If the body can often heal itself, how do we know when surgical treatment is called for? It usually depends on whether you are losing muscle function. While a slipped disc is painful, muscle weakness is a serious warning.

You should seek immediate medical attention if you experience a sudden loss of bowel control or bladder function, as this can indicate a rare but serious compression of the spinal cord. More commonly, I move toward surgery if a patient develops a neurological deficit, such as "foot drop," where you can’t lift your toes properly while walking.

When an affected nerve is squeezed so hard in the spinal canal that you lose motor power, the conversation changes. At this point, the pressure is winning, and waiting too long risks permanent nerve damage. My goal in this situation is to carefully remove the damaged disc material to rescue the nerve before that damage becomes lasting.

Exploring Less Invasive Options First

Most of the time, I want to see if we can get you better without an operation. Your vertebrae are separated by discs that act as shock absorbers, or round cushions, with a tough outer ring. When a herniated disk occurs, that inner material leaks out. The good news is that your body is remarkably good at fixing a bulging disk on its own. Your immune system can actually act to break down and reabsorb that material over time.

This is why conservative treatment is almost always our first choice for a herniated disk. We typically use a twelve-week window to let biology do its work. During this time, we use:

• Physical Therapy: I work closely with a physical therapist to help you strengthen the muscles in the lumbar spine (lower back) or cervical spine (neck).
• Pain Medication: We use specific meds to manage herniated disk symptoms and calm the nerve roots.
• Steroid Injections: I may use steroid injections to deliver medicine directly to the affected nerve for pain faster than oral meds alone.

Whether it's a cervical disc herniation or a lumbar issue, using these other symptom management tools is a strategy to see if your body can heal the slipped disc itself.

Returning to Your Routine

The first four to six weeks after any herniated disk event require some restraint. You should avoid lifting heavy objects or sitting for long periods. I usually recommend starting with a short walk and gradually increasing your activity.

My ultimate goal is to get you to a place where you don't have to think about your back at all. Maintaining a healthy weight and staying active are the best ways to protect your spine for the few months and years to come. I make sure every decision we make gets you back to physical activity and your favorite hobbies safely.