Lumbar Disc Herniation; Do I Really Need Surgery?

In general, most patients think that the diagnosis of a lumbar disc bulge means that surgery is inevitable.  This couldn’t be further from the truth.

There are so many misconceptions that revolve around low back pain that it’s always hard to decide where to start.  I have covered many of these issues in the past such as:

The list is much longer, but these are probably the top two concerns when it comes to low back pain.  It is rare that a MRI actually finds anything useful that actually relates to your current symptoms.  It is clear, however, that a MRI sets in motion a serious of events leading to epidurals and surgery.

That’s not to say that surgery is not a viable option for disc problems.  As successful as our office usually is treating disc problems, there have definitely been patients who have not responded to care and ended up in surgery, but it’s been a handful.

When someone does have a bona fide disc bulge that is creating his or her current symptoms, a very common concern centers around permanent nerve damage.  And it’s a very real concern.  Nerves don’t like pressure on them and if the pressure is sustained for a period of time permanent damage can occur.  For this reason, many surgeons will urge patients with a disc bulge to undergo surgery before this nerve damage occurs.

While pain in the leg is usually the first sign of nerve involvement (not all leg pain comes from a disc injury–the patterns associated with disc injury are very specific), muscle weakness takes some time to show up.  When this muscle weakness progresses, surgeons are quick to recommend surgery.

But, even at this stage of the game, is surgery for a lumbar disc bulge really needed?  This is the exact question asked by the authors of this particular study.  In it, researchers looked at  150 patients with sciatica due to a lumbar disc herniation and whose symptoms also included a moderate or severe muscle weakness to see how much of a difference having early surgery (versus more prolonged conservative care) had on the recovery of the muscle strength.  Here are the details:

  • In seven (10%) of the 70 patients who were assigned to early surgery the leg pain resolved even before surgery could be performed.
  • 32 patients (40%) of the 80 assigned to conservative care ended up having surgery because of severe pain.
  • While the muscle strength recovered faster in the surgery patients, by 26 weeks there was no difference in muscle recovery between the surgery and no-surgery group.
  • At the 1 year mark, complete recovery of muscle strength occurred in 81% of surgical patients and 80% of non-surgical patients.

The results from this study clearly indicate that muscle strength recovery is no different between those who have surgery and those who don’t.  Just like what I see in our office, some patients are in too much pain and decide for surgery, although the 40% number makes me wonder what “conservative care” really consisted of for the number to be that high.

Another very important tidbit that researchers discovered had to do with factors that led to a lower likelihood of having muscle strength actually return.  These were:

  • Those with a severe muscle weakness at the beginning were 540% more likely to still have weakness after a year.
  • Those with a lumbar disc herniation that took up more than 25% of the space in the spinal canal had a 640% higher chance of not experiencing any muscle strength recovery after a year.

The take home message is that, even with muscle weakness that occurs as the result of a lumbar disc bulge, your likelihood of recovery is just as good whether or not you have surgery.  The only two factors that would make your situation more dire would be a more severe muscle strength loss and a larger disc bulge.  Aside from that, if the pain is no unbearable, odds are that you are better off not going through the pain and risk of future problems that come from surgery for a lumbar disc bulge.

 

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.







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