Disc herniation: why surgery is not always needed
A disc herniation diagnosis sounds alarming, but in most people the herniation shrinks on its own and the pain settles without surgery. Here is what research shows — and when surgery really is needed.
What a disc herniation is
Flexible discs sit between the vertebrae. When part of a disc pushes out beyond its normal border, it can press on a nerve root. That causes the typical picture: low back pain spreading down the leg (sciatica), numbness or tingling.
A herniation can shrink on its own
A 2020 meta-analysis pooled data from 2,219 patients treated without surgery. On average, in 63% the herniation had shrunk or disappeared on a follow-up MRI [1]. The body treats the displaced disc fragment as foreign tissue and gradually reabsorbs it.
Surgery or no surgery
In a trial published in the New England Journal of Medicine, 283 patients with severe sciatica were split into two groups: early surgery or prolonged conservative care. Pain eased faster after surgery, but at one year disability was no different between the groups, and 95% of patients in both groups felt recovered [2].
What non-surgical treatment includes
- Staying active: the UK's NICE guidelines advise continuing normal activities rather than bed rest [3].
- Supervised exercise therapy.
- Pain relief and anti-inflammatory medicines prescribed by a doctor.
- Nerve blocks for severe pain.
When surgery is needed
NICE suggests considering surgery when non-surgical treatment has not helped and MRI findings match the symptoms [3]. Some situations, however, should never wait.
Sources
- Wang Y, Dai G, Jiang L, Liao S. The incidence of regression after the non-surgical treatment of symptomatic lumbar disc herniation: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 2020;21:530. doi.org
- Peul WC, et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 2007;356:2245–2256. repub.eur.nl
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. Guideline NG59. www.nice.org.uk
This article is based on scientific publications and clinical guidelines. It does not replace a consultation with a doctor.
