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I have a disc herniation, does that mean I need surgery?

This is a concern I get a lot not only from patients but from friends and fellow gym-goers. Some people with low back pain that end up getting an MRI come to find they have a disc herniation or disc bulge and resign themselves fairly quickly to surgery. So if you know or suspect you have a disc herniation, do you actually need surgery?

The unsatisfying answer is: it depends. To put some medical speak on it, the indication for surgery is progressive neurological deficit. What does that mean? Well let me back up a second an explain what happens with a disc herniation. In between each vertebrae in your spine you have a disc that acts as a shock absorber. The outer layer is thick and hard, the inner layer is liquid. Now also running down your back is the spinal cord, and all the nerves that go to your body exit the spinal cord in between your vertebrae, which is right where that disc lives. A ‘herniation’ means the thick outer layer has torn, and the inner liquid has been pushed out through the tear and may push on the nerves and/or spinal cord.

This does 2 things.

  1. It hurts. Just ask anyone who has had this. And the pain can radiate from the back all the way to the toes.
  2. It can reduce the activity of the nerve it is pushing on, causing numbness, tingling, and/or weakness.

Back to what I said earlier. ‘Progressive neurological deficit’ means that numbness, tingling, and weakness is getting worse and spreading, which may indicate the nerve is in danger of dying. Luckily, this is a SMALL percentage of those with low back pain and herniations. Even if you have numbness, tingling, or weakness, these are all things that can be treated effectively and to complete resolution outside of surgery (as long as they don’t progress).

If you don’t need surgery, what do you need?

There is a lot that can be done with disc herniations. Simple spinal mobilizations can help to directly reduce nerve irritation and decrease numbness, tingling, and weakness. Spinal adjustments administered by a Chiropractor are very powerful at helping to restore normal activity of joints after an injury, decreasing pain, and reducing muscle tightness. Once your pain levels have gone down, ergonomic (posture) changes can be made to make sure the pain doesn’t come back, and strengthening exercises can be performed for the core and hips.

The long and short of it is that the vast majority of disc herniations respond well to simple treatments, and those people don’t have to worry about getting put on an operating table. If you’ve been told you need surgery for your disc herniation or are worried you might need low back surgery, make sure to get evaluated by a knowledgeable Doctor who does a thorough exam, not just order an MRI. The conservative route may take a couple weeks to months to get you back in shape, but believe me, recovery from surgery will take much, much longer.