Question: When is the right time to undergo surgery for lumbar herniated disc?

I've suffered for several years with chronic low back pain. After some chiropractic sessions, I started to suffer pain along my right leg, and now it’s difficult to stand and walk for a long period of time. The leg pain is worse than the low back pain. An MRI uncovered a lumbar herniated disc at L5-S1. I’ve since tried cortisone injections, epidural injections and acupuncture with no pain relief.

One neurosurgeon recommended surgery, a fusion with titanium cages to eliminate the herniated portion of the disc. Another neurosurgeon said that my disc herniation can be treated with a microdiscectomy, but surgery is not urgent. I decided to postpone surgery and try chiropractic treatment for 2 more weeks.

Do you think I have undergone a sufficient amount of conservative treatment to avoid surgery to treat the lumbar herniated disc? If surgery is most likely the next step, is fusion the best option, or is a microdiscectomy enough? What are the potential advantages of a fusion for a low back herniated disc (versus other surgical procedures)?

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Doctor’s response: Have surgery for lumbar herniated disc when conservative treatment options have been exhausted

It does sound as if you have pretty much maximized your conservative treatment and your symptoms are severe. Usually, if the leg pain from a large disc herniation is severe and has not gone away after about six to twelve weeks of non-surgical treatments, surgery is the best way to get better the quickest.

If you have mainly leg pain from a large herniated disc, a microdiscectomy would usually be all that is needed. Although a fusion surgery may be necessary in the future, there probably is about a 90-95% chance that it would never be needed. In my own practice, I usually will only do the microdiscectomy and the vast majority of patients do well.

It is also far easier to recover from a minimally invasive microdiscectomy than a much more invasive fusion surgery. Since a fusion surgery will forever change the mechanics in the back, in my opinion it should only be done for a herniated disc in the rare cases where patients still have low back pain after a discectomy.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.