When does one need surgery for a herniated disc?

Introduction

In up to ninety percent of all patients with a herniated disc, purely conservative treatment is sufficient. In some patients the symptoms disappear completely after a few weeks. There are different constellations of findings, under which an operation is possible.

If the conservative treatment fails, surgery is considered. In the presence of paralysis and pain that cannot be treated with medication, a surgeon must be consulted. In addition, there are constellations of findings in which a disc surgery can be performed but is not absolutely necessary. In case of a herniated disc, the choice of treatment depends largely on the severity of the symptoms, warning signs of nerve damage and the patient’s wishes.

When do you always have to operate on a herniated disc?

In principle, surgery must always be performed in case of a herniated disc, if the patient is threatened by serious nerve damage. If the intervertebral disc presses on a nerve root due to the prolapse, the pain typically radiates out If a herniated disc is located in the area of the cervical spine (cervical spine), pain typically radiates into the arm and shoulder. In addition, numbness and tingling in hands and arms are possible.

A weakness of the arm muscles can occur. A herniated disc in the lumbar spine (lumbar spine) can be accompanied by pain radiation in the legs and/or buttocks, tingling and/or paralysis of the leg muscles. Important warning signs for nerve damage are paralysis symptoms.

These include muscular weakness and paralysis with impaired fine and gross motor skills, which can manifest itself as dropping objects or walking unsteadiness. In addition, it is absolutely necessary to operate if the affected person suffers from involuntary urination and/or defecation. This speaks for paralysis of the bladder and rectum.

A slipped disc in the lumbar spine can cause sudden impotence. The mentioned warning signs of nerve damage, especially paralysis, are an absolute emergency surgery indication. A large herniated disc can press against the spinal cord and cause a (complete) paraplegic syndrome.

A paraplegic syndrome manifests itself through paralysis and sensitivity disorders. If the intervertebral disc presses against the nerve fiber bundle in the lower lumbar spine, the so-called cauda equina, paralysis of the thigh muscles, rectum and bladder occurs, as well as loss of sensitivity in the anal and genital area and in the thigh area (“breeches area”). A Kauda syndrome is also an absolute surgical emergency. Without surgery, root death with permanent damage occurs. Another indication for surgery is pain in the affected person, which cannot be treated effectively and is perceived by the patient as intolerable.