If I have a Disc Herniation, do I Need Surgery?

If I have a Disc Herniation, do I Need Surgery?

If I have a Disc Herniation, do I Need Surgery?

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Many people are diagnosed with disc herniation throughout their lives. This can happen in any portion of the spine and is most often an acute event.

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A disc herniation is when the tough outer covering around one or more of the discs in the spine is interrupted and a piece of disc material escapes. With this there also a release of pain inducing chemical irritants around the area.  Where the pain, numbness and tingling occur will give us a clue which level this disc is located. Generally we use MRI’s or CT scans to give us a definitive diagnosis.
In your neck (cervical), the symptoms of nerve impingement (disc pushing against the nerve) would be pain, numbness and tingling of the arm and possibly the hand of the affected side. If the disc is herniated in the center and pressing into the spinal cord, there may not be any pain, but weakness in the arm(s) and/or leg(s) may be present. Clumsiness or dropping things can also be associated with this.
In your back (lumbar) the symptoms would be in the legs, with pain, numbness or tingling that can go to any part of the leg(s) including the toes and the bottom of the feet. This is commonly called sciatica. If the herniation is central, you may have minimal symptoms unless it is very large. If it blocks the spinal canal there could be symptoms such as paralysis, urinary and bowel incontinence, foot drop or sexual dysfunction. This would require an immediate trip to see a surgeon.
But what about the rest? Is surgery always necessary?
It is actually unlikely you will need surgery. Our bodies do an amazing job of healing themselves, with or without our help. As time goes on most disc herniations shrink back toward the disc and gradually heal over. This is not to say that they are not painful, but in most cases the pain will not last forever.  It is said that a herniated disc will heal itself 95% of the time after 3 months. The hardest part of this is having patience and having confidence in your physician. We all want to go for the quick fix but surgery, no matter how small, should be the last resort.
Several options of treatment that may help to accelerate the healing of a disc are available.

  • Physical therapy and chiropractic care (no adjustments with an acute disc)  often help maintain proper body alignment, decrease spasm and improve range of motion.
  • For continued discomfort, epidural steroid injections are can be a treatment of choice. The steroid (often referred to as cortisone) is injected next to the area where the disc is pressing on the nerve. It is thought that this decreases swelling of the tissues and the nerve, thereby decreasing pain and encouraging healing.

It is important to note if two injections don’t help, it is very unlikely that any more will. Steroids should be used sparingly as they have several long lasting side effects especially in diabetics and people with osteoporosis.  Time is the biggest factor. If you can control the discomfort enough to get through the 3 months, there is a much lower chance of surgery being necessary.

 

Citations

  • Gugliotta M, da Costa BR, Dabis E, Theiler R, Jüni P, Reichenbach S, Landolt H, Hasler P. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016 Dec 21;6(12):e012938. PubMed PMID: 28003290

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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