A herniated disc, also known as a slipped or ruptured disc, occurs when the soft inner material of the disc bulges out through a weak area in the tougher exterior. This can cause pain and other symptoms in the back and extremities. For most people, herniated discs are manageable with conservative treatments like rest, medication, physical therapy and injections. However, in some cases, a herniated disc may require surgery. This article will cover quick answers about when a herniated disc is considered serious enough to warrant surgery.
What is a Herniated Disc?
The spine is made up of small bones called vertebrae that are cushioned by discs. These discs have a tough outer layer called the annulus fibrosus and a soft gel-like center called the nucleus pulposus. A herniated disc occurs when the nucleus pushes through the annulus and puts pressure on the spinal nerves. This most often happens in the lumbar spine (lower back) and the cervical spine (neck), which bear the most weight and allow the most movement.
What Causes a Herniated Disc?
There are several factors that can lead to a herniated disc, including:
– Wear and tear – As we age, the discs start to break down and become more susceptible to injury.
– Injury – A significant trauma like a car accident or a fall can cause a disc to rupture.
– Improper lifting – Using the wrong posture and lifting heavy objects can put too much strain on the discs.
– Genetics – Some people are just born with thinner, weaker disc walls.
– Repeated stress – Jobs or activities with repetitive bending and twisting can weaken the discs over time.
What are the Symptoms of a Herniated Disc?
Symptoms of a herniated disc depend on the location but may include:
– Lower back pain that radiates down the leg (sciatica).
– Numbness, tingling or weakness in the leg or foot.
– Neck pain that radiates down the arm.
– Muscle weakness in the arm or hand.
– Loss of bladder or bowel control (a medical emergency).
The pain is often described as a shooting, electric or burning sensation. Coughing, sneezing or straining often makes the symptoms worse. Usually only one side of the body is affected.
When is Surgery Needed for a Herniated Disc?
Most herniated discs are treated conservatively with rest, medication, physical therapy and sometimes epidural steroid injections. Surgery may be considered if:
– Symptoms last more than 6 weeks despite aggressive nonsurgical treatment.
– There is significant weakness or numbness in a leg or arm.
– Bladder or bowel control are affected.
– Pain is severe and debilitating.
– A large portion of the disc is ruptured.
The main surgical options are:
Discectomy
This procedure removes the portion of the disc that is pressing on the nerve. It is one of the most common spine surgeries and has a high success rate at relieving symptoms.
Spinal Fusion
The two vertebrae are permanently joined together to stop painful motion. This may be done if more than one disc is affected.
Disc Replacement
The damaged disc is removed and replaced with an artificial implant made of metal and plastic. This preserves motion and may prevent future degeneration.
When Should I See a Doctor?
See your doctor if you have severe back or neck pain that:
– Lasts more than 1-2 weeks
– Is worse when sitting, coughing, sneezing or straining
– Radiates down the leg or arm
– Causes numbness, tingling or weakness
Red flags that require urgent medical evaluation include:
– Loss of bowel or bladder control
– Sudden weakness in a leg or arm
– Fever or unexplained weight loss along with the other symptoms
How is a Herniated Disc Diagnosed?
To diagnose a herniated disc, the doctor will:
– Take a medical history and ask about symptoms.
– Perform a physical and neurological exam to check for weakness, numbness and pain.
– Order imaging tests like an MRI or CT scan to see the herniation.
– Do tests like electromyography to assess nerve damage.
Can a Herniated Disc Resolve on Its Own?
Yes, in many cases a herniated disc will heal over time without surgery. The protruding material may retract back into place or diminish in size. However, this process takes around 4-6 months for most people. Surgery may be required if the symptoms are severe and persistent.
What is the Typical Recovery Time?
Recovery time depends on the treatment.
– With conservative treatment, pain often improves within 6-12 weeks but ongoing physical therapy may be needed.
– After discectomy surgery, most people can return to light activities within 1-3 months. Heavier activities may require 6 months.
– Spinal fusion requires a longer recovery of 3-6 months with activity restrictions.
– With artificial disc replacement, recovery is quicker at around 6-12 weeks.
How Can I Manage Symptoms at Home?
To help relieve pain and improve healing:
– Limit activities that worsen pain like bending, lifting and twisting.
– Apply cold packs for 20 minutes several times per day, especially after activity.
– Take over-the-counter medications like NSAIDs (ibuprofen, naproxen).
– Sleep on your side with a pillow between your knees.
– Use good posture and proper lifting techniques.
– Try gentle stretches and exercises to build core strength.
– Use a firm mattress and avoid sitting for long periods.
When Can I Return to Work?
Returning to work depends on the kind of job and how much it aggravates your symptoms. Those with physically demanding jobs may require more recovery time. In general:
– With conservative treatment, you may be able to return to light or modified duty within 1-4 weeks.
– After discectomy surgery, plan to take at least 1-3 months off work.
– Spinal fusion may require up to 6 months before returning to work.
– With artificial disc replacement, many people can go back after 6-12 weeks.
Discuss with your doctor when it is safe to return based on your symptoms and job duties. You may need work restrictions at first.
What are the Long-Term Outcomes?
With proper treatment, most patients see significant improvement in leg and back pain caused by a herniated disc. However, re-injury or re-herniation is possible if the activities that caused it are resumed too soon. Long-term outcomes include:
– Up to 90% of patients have good-to-excellent results after discectomy surgery.
– After spinal fusion, around 85% experience reduced pain, but motion is limited.
– Artificial disc replacement has promising 5-10 year outcomes with low reoperation rates.
– Conservative care also has generally favorable long-term results if treatment is consistent.
– Exercise and physical therapy can help strengthen the core muscles and prevent future herniations.
– Some people continue to experience mild back pain and radiculopathy that can be managed with minimal treatment.
Can a Herniated Disc Lead to Permanent Damage?
In most cases, the nerve damage from a herniated disc is reversible with proper treatment and time. Permanent nerve damage is rare but can occur if:
– The disc material compresses the nerve for an extended time.
– There is significant inflammation and scarring around the nerve.
– The nerve is subjected to extreme pressure or stretching.
Symptoms like muscle weakness, numbness and pain may persist if the nerve does not fully recover. This is more likely with severe herniations and delays in treatment. Surgery may still help relieve symptoms.
Prevention
While herniated discs often occur from age-related wear and tear, there are some preventive measures that may help, including:
– Maintain proper posture and use good body mechanics when lifting.
– Exercise regularly to build core, back and abdominal strength.
– Manage weight to reduce load on the spine.
– Avoid smoking, as it can contribute to disc degeneration.
– Treat other back injuries promptly to prevent added stress.
– Listen to your body and stop activities that cause pain.
– Consider physical therapy to learn strengthening and stretching techniques.
– Use ergonomics at home and work to create a spine-friendly environment.
Conclusion
Herniated discs are common causes of back and leg pain but do not always require surgery. Mild cases can be managed with rest, medication, injections and physical therapy. However, prompt surgical evaluation is recommended if there is severe pain or neurological symptoms like leg weakness. While recovery takes time, most patients see improvement with a combination of nonsurgical treatment and activity modification. With proper preventive care, many herniated discs can potentially be avoided.