Herniated Disc Surgery: Indications, Procedure & Recovery

Herniated disc surgery for the lumbar, cervical, or thoracic spine may be recommended when pain and discomfort do not improve with medication and physical therapy. It may also be considered when a herniated disc compresses nerves and causes weakness or loss of sensation.

The exact procedure can vary. In some cases, the surgeon uses a traditional incision to reach the spine, while in others, newer and less invasive techniques may be used, sometimes with the help of a surgical microscope.

This surgery is performed by an orthopedic surgeon or neurosurgeon under general anesthesia. Rehabilitation physical therapy is important following surgery because it can help improve symptoms and support a faster return to daily activities.

Indications for surgery

Herniated disc surgery is indicated in the following situations:

• Pain that does not improve with medication and physical therapy

• Nerve compression

• Weakness, loss of strength, or loss of sensation in the arms or legs

• Loss of bladder or bowel control

• Difficulty walking or doing everyday activities

Surgery for a herniated disc may be recommended by an orthopedic surgeon or a neurosurgeon, depending on how severe the herniation is, what symptoms you have, and whether any nerve problems are getting worse.

According to the American Association of Neurological Surgeons, surgery may be considered when pain continues despite medication and physical therapy, or when there are progressive neurological deficits, loss of bowel or bladder function, or difficulty standing or walking.

For a lumbar herniated disc, surgery is usually considered if pain continues after about 6 weeks of treatment with medication and physical therapy. For a herniated disc in the neck, surgery is generally considered after around 6 months of persistent symptoms.

Preparing for surgery

To prepare for herniated disc surgery, it is recommended to:

• Tell your doctor about any medications you are taking, since you may need to stop anticoagulants a few days before surgery.

• Stop taking anti-inflammatory medications, vitamin E supplements, multivitamins, and herbal supplements at least 10 days before surgery.

• Stop smoking, if you smoke.

• Keep your blood sugar under control, if you have diabetes.

• Do not eat or drink for at least 8 hours before surgery, or as directed by your doctor.

You should also complete any tests your doctor orders, such as a preoperative evaluation, X-ray, MRI, or CT scan, and bring them to the hospital on the day of surgery.

Procedure technique

The type of surgery can vary based on where the herniated disc is, which techniques are available at the hospital, and each person’s specific situation. The orthopedic surgeon or neurosurgeon will determine which surgical approach is best.

The main types of herniated disc surgery are:

1. Traditional surgery

This procedure is done through an incision in the skin to reach the spine.

The access point is chosen based on the closest route to the affected disc. It may be from the front, which is common for cervical herniation, or from the side or back, which is more common for lumbar herniation.

This surgery is usually performed under general anesthesia, and part or all of the damaged intervertebral disc may be removed.

After that, a material may be used to join the two vertebrae, or an artificial material may be used to replace the removed disc.

Surgery time varies depending on the location and severity of the herniation, but it usually lasts about 2 hours.

2. Minimally invasive surgery

Minimally invasive surgery uses newer techniques that require a smaller skin incision. This allows less disruption of the structures around the spine, a shorter procedure time, and a lower risk of complications such as bleeding and infection.

The main techniques used are:

• Microsurgery: the intervertebral disc is treated with the help of a surgical microscope, which allows for a smaller incision.

• Endoscopic surgery: this technique is done through small openings in the skin, which may allow faster recovery and less postoperative pain.

Minimally invasive surgery may be performed with local anesthesia and sedation, and it usually lasts about 1 hour or less.

During surgery, a radiofrequency or laser device may be used to remove the herniated part of the disc. Because of this, this type of procedure may also be referred to as laser surgery.

Recovery time

Recovery varies depending on the type of surgery. Hospital stay is usually about 2 days after minimally invasive surgery and may be up to 5 days after conventional surgery.

Returning to activities such as driving or going back to work is also usually faster after minimally invasive surgery.

With traditional surgery, a longer period of rest is usually needed before returning to work. More intense activities, such as exercise, are only allowed after the surgeon evaluates your recovery and your symptoms improve.

Postop instructions

During recovery, pain relievers or anti-inflammatory medications prescribed by the doctor should be used to help control pain.

Based on guidance from the American Association of Neurological Surgeons and the American Academy of Orthopaedic Surgeons, rehabilitation physical therapy and supervised exercises after spine surgery can help restore movement, improve function, and support a return to daily activities.

In addition, you should avoid lifting heavy objects, driving, or doing household chores for at least 2 to 6 weeks after surgery, based on your doctor’s instructions.

Potential risks

The main complications of herniated disc surgery are:

• Ongoing spine pain

• Infection

• Bleeding

• Injury to nerves around the spine

• Difficulty moving the spine

The risk of complications from herniated disc surgery is relatively low, mainly because newer techniques and equipment are increasingly being used.

Even so, because these risks exist, surgery is generally reserved for people with severe symptoms or for those who do not improve with other forms of treatment.