Herniated Disc Case: Spine Surgeon Viewpoint
Conservative Care for the Herniated Disc
The patient has not yet maximized her conservative care to treat the herniated disc and there would still be some conservative care options available such as physical therapy and epidural injections. Oral steroids could also be tried; however, if she is having a lot of pain and dysfunction and there has been no improvement after eight weeks, it would be reasonable to consider a surgical discectomy. Most symptoms associated with a disc herniation, if they are going to heal on their own, will do so within about six to twelve weeks. If symptoms persist despite conservative care within this time frame, then spine surgery might be indicated.
Spine Surgery for the Herniated Disc
A microdiscectomy (microdecompression) surgery is one of the most common spine surgeries performed and is also one of the most reliable. There is a minimal amount of morbidity associated with the procedure, and many patients can return to their former level of functioning within 1-3 weeks. The success rate is high—at least 90-95% of patients will have good relief of their leg pain with this type of spine surgery.
Although controversial, some spine surgeons may also consider doing a spine fusion at the same time as a discectomy. She has a very degenerated disc at L5-S1 and a history of other episodes of back pain. Fusing this segment with surgery might help prevent other episodes of back pain, but her episodes have not been severe in the past and she has had little dysfunction. Fusing the segment at this time is probably unnecessary and there is only a 5-10% chance that she will need a spine fusion surgery in the future. A spine fusion procedure could add morbidity to a procedure that normally could be done either as an outpatient or an overnight stay. Also, it takes many months for a bone graft that is used in a spine fusion surgery to heal, and the patient’s activity might be restricted during that time period.
