What is a herniated disc?
The spine is made up of individual bones known as vertebrae. Intervertebral discs are discs of cartilage that sit between the vertebrae.
The function of the intervertebral discs is to support the spine and act as shock absorbers between the vertebrae.
There are normally 23 discs in the human spine. Each disc is made up of three components:
- Nucleus pulposus: This is the inner gel-like portion of the disc that gives the spine its flexibility and strength.
- Annulus fibrosis: This is a tough outer layer that surrounds the nucleus pulposus.
- Cartilaginous endplates: These are pieces of cartilage that sit between the disc and its adjoining vertebrae.
In a herniated disc, the annulus fibrosis is torn or ruptured. This damage allows part of the nucleus pulposus to push through into the spinal canal. Sometimes, the herniated material can press on a nerve, causing pain and affecting movement.
Each year, herniated discs affect around 5–20 of every 1,000 adults between the ages of 20 and 49 years old.
A herniated disc can occur anywhere in the spine. The two most common locations are the lumbar spine and the cervical spine. The lumbar spine refers to the lower back, while the cervical spine refers to the neck region.
Who needs surgery?
Most herniated discs do not require surgery. In approximately 9 out of 10 people, symptoms will resolve over days to weeks.
Some people who have a herniated disc do not experience any symptoms at all.
Sometimes, however, the herniated disc presses against a nerve in the spinal column. This can cause pain, numbness, or weakness in the part of the body where the nerve travels.
The doctor may recommend surgery, depending on the person’s level of pain and disability.
In rare cases, a herniated disc may affect the nerves that control the bladder and bowel. Surgery will be necessary to relieve pressure on the nerves and restore bladder and bowel function.
If possible, a person may want to seek care at a hospital that uses a multidisciplinary approach to making decisions about surgery.
A 2017 pilot study suggests that a team of different healthcare specialists — including surgeons, anesthetists, and physical therapists — may be less likely to recommend unnecessary spinal surgery that one person who decides on their own.
The purpose of herniated disc surgery is to ease pressure on the nerve, thereby alleviating pain and other symptoms.
A doctor may use one of the following three techniques to alleviate pressure on the nerve:
- Open discectomy: The surgeon performs open surgery to remove the herniated section of the disc.
- Endoscopic spine surgery: The surgeon uses a long thin tube, or endoscope, to remove the herniated section of the disc. The procedure is minimally invasive, requiring a tiny incision. Only a small scar will form, resulting in a quicker recovery.
- Surgery on the core of the spinal disc: The surgeon uses instruments to access the core of the spinal disc then uses a vacuum to remove the core. This makes the spinal disc smaller, which reduces pressure on the nerve. The surgery is only possible if the outer layer of the disc is not damaged.
Other surgical interventions for a herniated disc include:
Laminotomy or laminectomy
The lamina is a part of the vertebrae that covers and protects the spinal canal. Sometimes, doctors need to remove part or all of the lamina to repair a herniated disc.
A laminotomy involves the removal of part of the lamina, while a laminectomy is removal of the entire lamina.
Both procedures involve making a small incision down the center of the back or neck over the area of the herniated disc. After removing part or all of the lamina, the surgeon performs a discectomy to remove the herniated disc.
Laminotomies and laminectomies can be lumbar or cervical:
- Lumbar procedures: These help to relieve leg pain or sciatic pain that a herniated disc causes in the lower back region.
- Cervical procedures: These help to relieve pain in the neck and upper limbs that a herniated disc causes in the neck region.
Following a laminotomy or laminectomy, a spinal fusion (SF) may be necessary to stabilize the spine. An SF involves joining two bones together with screws.
People who have undergone an SF may experience pain and feel as if the treatment is restricting certain movements.
The likelihood of needing an SF depends on the location of the herniated disc. Typically, lumbar laminotomies require an SF.
Cervical laminotomies require an SF if the surgeon operates from the front of the neck. The same procedures rarely require an SF if the surgeon operates from the back of the neck. The point the surgeon works from depends on the exact location of the herniated disc.
Some people who undergo laminotomy may be candidates for artificial disc surgery instead of an SF.
Artificial disc surgery
Artificial disc surgery (ADS) is an alternative to spinal fusion. In ADS, the surgeon replaces the damaged disc with an artificial one.
A surgeon will usually associate this method with less pain and less restricted movement in comparison to SF procedures.
Recovery process and timeline
According to the North American Spine Society, people who undergo surgery for a herniated disc earlier rather than later may have a faster recovery time. They may also experience improved long term health.
Typically, most people can go home 24 hours after a herniated disc operation. Some may even be able to go home the same day.
Doctors recommend that people recovering from herniated disc surgery avoid the following activities for around 4 weeks:
- sitting for long periods
- lifting heavy weights
- bending over
Some exercises may be beneficial for people who have had herniated disc surgery. However, they should consult their doctor or surgeon before attempting any strenuous activities.
Sometimes, doctors may suggest rehabilitation therapy after surgery. People who follow a rehabilitation program after herniated disc surgery may achieve a shorter recovery time and improved mobility.
Discectomies hardly ever result in complications. However, in rare cases, people may experience the following:
- tears in the spine’s protective lining
- injury to the nerve
In around 5% of people, the problematic disc may rupture again, causing symptoms to recur.
Herniated disc surgery can be an effective treatment for many people with challenging pain. However, surgeons cannot guarantee that symptoms will disappear after surgery.
Some people may continue to experience herniated disc pain after the recovery period. In some cases, the pain may worsen over time.
Other treatment options
People who develop a herniated disc should limit their activities for 2 to 3 days. Limiting movement will reduce inflammation at the site of the nerve. Although it may seem counterintuitive, doctors do not recommend bed rest, however.
If those treatments are ineffective, doctors may recommend other nonsurgical options, such as selective nerve root blocks. These treatments are local numbing agents that doctors inject into the spinal cord to alleviate herniated disc pain.
A herniated disc can cause disabling pain. In many cases, nonsurgical treatment options offer effective pain relief. If there is no improvement, a doctor may recommend herniated disc surgery.
The type of surgical procedure a person undergoes depends on several factors. These include the location of the herniated disc, the severity of the pain, and level of disability it causes.
Most people can return to their usual activities around 4 weeks after herniated disc surgery. People who follow a rehabilitation program after surgery may experience a shorter recovery time and better mobility.
People who have a herniated disc should talk to their doctor about the treatment options that are available to them.