DEAR MAYO CLINIC: I was recently diagnosed with a herniated disk in my back. It’s causing quite a bit of pain throughout one of my legs. My doctor says the disk is basically choking the nerves in my lumbar spine. Surgery has been recommended, but I’m not sure I want surgery. I’ve heard it’s not always effective. Will my condition worsen without it?
ANSWER: A herniated disk often can be effectively treated without surgery. Medication and physical therapy typically ease the pain and discomfort caused by a herniated disk. But in some cases, particularly when the injured disk is compressing a nerve, surgery may be helpful.
Spinal disks are a special kind of joint located between the spine bones, called vertebrae, that stack up to create your spine. The disks serve as cushions between the vertebrae. They have a soft center wrapped within tougher exterior layers. A herniated disk happens when some of the softer material pushes out through a crack in the outer layers of the disk.
Herniation can happen to a disk for a number of reasons. Sometimes, using your back muscles instead of your leg muscles to lift large, heavy objects can overload your spine and lead to a herniated disk. Twisting and turning while lifting may damage the disk joint. Rarely, a traumatic event — such as a fall or a blow to the back — can cause a herniated disk. Most often, though, it’s not a single event that causes a disk to herniate. Instead, it results from a gradual process of degeneration that happens due to aging and wear and tear on the disk over time.
Treatment for a herniated disk usually starts with efforts to relieve symptoms. A short period of rest (no longer than about 24 to 36 hours) can help. Research has shown that longer periods of bedrest are not helpful.
Medications often are used to ease discomfort. In cases that involve nerve irritation, medication designed to relieve nerve pain may be useful. Muscle relaxants can be helpful if you experience muscle spasms as a result of a herniated disk.
Manual therapy also may help. A physical therapist or another musculoskeletal specialist can show you exercises and other techniques that can reduce herniated disk symptoms and promote an earlier return to work or other daily activities.
Surgery typically is recommended only after other treatments haven’t worked or when symptoms are severe. The procedure most frequently used for a herniated disk is called a diskectomy. During this surgery, a surgeon removes the part of the disk that is placing pressure on the nerve. In some special cases, the entire disk may need to be removed. This is uncommon, but when it happens, the surgeon usually fills the space with a piece of bone, and the vertebrae on either side are fused together with metal hardware.
Diskectomy often effectively reduces herniated disk symptoms when nerve compression is the source of the problem. If the pain is due to other factors, then the surgery may not help. Even if it eases pain for a while, a diskectomy may not be a permanent cure. The process that led to the herniated disk initially may continue, leading to additional disk injury in the future. To help keep your spine healthy after surgery, your doctor may suggest weight loss, exercise or physical therapy. You also may need to limit some activities that include bending, twisting or lifting.
It is hard to know if your condition will worsen without surgery. But it is unlikely that it will get better without any treatment. Discuss your misgivings about surgery with your doctor. Ask if more conservative treatments might be appropriate at this time. If your doctor still recommends surgery, make sure you understand all the possible risks and benefits and get all your questions answered before you move forward. — Paul Huddleston, III, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.