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Herniated disc: Should I have surgery?
Get the facts
Your options
- Have surgery for your herniated disc.
- Don't have surgery.
This decision guide is for you if your herniated disc is in your low back. For information about herniated discs in the neck area of the spine, see the topic, Cervical Disc Herniation.
Key points to remember
- Most people get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.
- Surgery may be a good choice if you have sciatica—severe pain, numbness, or weakness in your buttocks and legs—that has not gotten better with nonsurgical treatment.
- If you have medium to very bad pain, you will probably feel better sooner if you have surgery. But after 5 to 10 years, your ability to do your daily activities will probably be about the same whether you have surgery or not.1
- If a doctor recommends that you have surgery, it's a good idea to get a second opinion. You need to get as much information as possible before you make this decision.
- Surgery for a herniated disc doesn't usually cause problems. But there is a slight risk of damaging nerves or the spine during surgery. Other possible problems include problems from the anesthesia and infection that causes more damage.
- Your doctor may recommend several weeks of physical therapy and home exercises after surgery.
What is a herniated disc?
The bones that form the
spine—your vertebrae—are cushioned by small, spongy discs. When these discs are
healthy, they act as shock absorbers for the spine and keep the spine flexible.
But when a disc is damaged, it may bulge or break open. This is called a
herniated disc 
. It may also be called a slipped or
ruptured disc.
A herniated disc doesn't always cause symptoms. But when it presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels.
If the herniated disc is in the lower back, it can cause pain and numbness in the buttock and down the leg. This is called sciatica (say "sy-AT-ih-kuh"). Sciatica is the most common symptom of a herniated disc in the low back.
Usually a herniated disc will heal on its own over time. About half of people with a herniated disc get better within 1 month, and most are better within 6 months. Only about 10 people in 100 eventually have surgery.2 That means 90 out of 100 people don't have surgery.
What kinds of surgery are done for a herniated disc?
The most common surgeries are:
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Your doctor may recommend a rehabilitation program after surgery, which can include physical therapy and home exercises.
When is nonsurgical treatment used for a herniated disc?
Most herniated discs heal after a few months of nonsurgical treatment. This treatment can include:
- A short period of rest.
- Medicine for pain relief, including pain pills, muscle relaxants, and steroid shots.
- Physical therapy.
- An exercise program prescribed by a doctor.
About half of people with a herniated disc in the low back recover within 1 month. And within 6 months, most people recover. Only 10 out of every 100 eventually have surgery.2
If you are getting better after 6 weeks of nonsurgical treatment, that's a good sign that your body will continue to heal without surgery. Often the body reabsorbs the material from the disc, which helps the pain go away. This process is called resorption.
How well does herniated disc surgery work?
Surgery works well for many people, but not for everyone.
A study begun in 1990 followed about 500 people with low back pain caused by a herniated disc. Some had surgery and some did not. Information was gathered 5 years and 10 years after the beginning of the study.4, 1
Here's what the study found:
| Number who said their pain was better 5 years later | Number who said their pain was better 10 years later |
Of those who had surgery | 70 out of 100 | 71 out of 100 |
Of those who didn't have surgery | 56 out of 100 | 56 out of 100 |
The study also looked at how people felt in general 10 years after their treatment:
| Number who were satisfied with their situation | Number who were able to work | Number who would choose the same treatment again |
Of those who had surgery | 71 out of 100 | 81 out of 100 | 87 out of 100 |
Of those who didn't have surgery | 56 out of 100 | 75 out of 100 | 76 out of 100 |
Some people decide to have surgery because they need to go back to work or their other activities as soon as possible. If your job doesn't require you to be very active, you can probably go back to work 2 to 4 weeks after surgery. If your job is physically demanding, you'll need 8 to 12 weeks.
What are the risks of surgery?
Most people have no problems with back surgery, the most common surgery for herniated discs. But like most surgeries, there are some risks:
- There is a slight risk of damaging nerves or the spine during surgery.
- Some people form a lot of scar tissue in the area of the surgery. That tissue can press against nerves and cause pain.
- There is some risk of infection, which may cause more damage. An infection may require antibiotics and another surgery.
- Serious side effects of anesthesia are uncommon but can include trouble breathing, heart attack, stroke, and even death.
Why might your doctor recommend herniated disc surgery?
Your doctor might recommend surgery for your herniated disc if:
- You have very bad leg pain, numbness, or weakness (sciatica) that keeps you from being able to do your daily activities.
- Your leg symptoms do not get better with at least 4 weeks of nonsurgical treatment.
- Your symptoms are getting worse.
- You need to get better quickly because of your job.
- Tests show that your herniated disc can be treated with surgery.
- You are able to follow a rehabilitation program for a number of weeks after surgery.
If you have symptoms, see the
Interactive Tool: Should I Consider Surgery for My Low Back Problem? 
to see whether surgery might help.
Compare your options
What is usually involved?
- You are asleep or numb during the surgery.
- You will probably stay in the hospital overnight.
What are the benefits?
- Surgery works well for many people with medium to very bad pain.
- Surgery offers faster pain relief than other treatment.
- With surgery, most people can go back to work sooner.
What are the risks and side effects?
- Surgery does not always work, or it may not work any better than other treatment.
- There is a slight risk of damaging the spine or nerves.
- There is some risk of infection.
- There are risks with anesthesia.
What is usually involved?
- You try rest, physical therapy, exercises, and medicines.
What are the benefits?
- You avoid having surgery.
- Nonsurgical treatments work for most people.
- Research shows that 10 years after treatment, people who did not have surgery are just about as likely to be able to do their daily activities as people who had surgery.
What are the risks and side effects?
- Pain relief comes more slowly than with surgery.
Personal stories
Are you interested in what others
decided to do? Many people have faced this decision. These
personal stories may help you decide.
For more information, see the topic Herniated Disc.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for a herniated disc
Reasons not to have surgery
I am comfortable with the idea of having back surgery.
I don't like the idea of surgery at all.
I've tried exercises and medicines for a few months, and I don't think they have helped me.
I think the exercises I've been doing or the medicines I'm taking are starting to help.
I am in a lot of pain. I don't see how I can stand it much longer.
My pain isn't bad enough that I need to have surgery right now.
It's very important that I get my pain under control so that I can go back to work as soon as possible.
Time is not a problem for me. If I get better slowly using exercises and/or medicine, that's okay with me.
I'm not worried about how much this operation will cost.
I don't have insurance and don't see how I can afford this operation.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery for herniated disc
NOT having surgery
What else do you need to make your decision?
Check the facts.
If I have back pain because of a herniated disc, I probably need surgery.
- True Sorry, but that's wrong. Most people don't need surgery. They get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.
- False You're right. Most people don't need surgery. They get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.
- I'm not sure It may help to go back and read "Key points to remember." Most people don't need surgery. They get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.
Surgery might help me, because I have really bad pain from sciatica.
- True That's true. If you've tried nonsurgical treatment for sciatica and haven't gotten better, surgery may be a good choice for you.
- False Actually, it's true. If you've tried nonsurgical treatment for sciatica and haven't gotten better, surgery may be a good choice for you.
- I'm not sure It may help to go back and read "Why might your doctor recommend herniated disc surgery?" If you've tried nonsurgical treatment for sciatica and haven't gotten better, surgery may be a good choice for you.
Years from now I will probably feel just as good without surgery as I would if I have surgery.
- True That's right. Research shows that you may feel better sooner with surgery, but in the long run, nonsurgical treatment works about as well.
- False Sorry, you're wrong. Research shows that you may feel better sooner with surgery, but in the long run, nonsurgical treatment works about as well.
- I'm not sure It may help to go back and read "How well does herniated disc surgery work?" Research shows that you may feel better sooner with surgery, but in the long run, nonsurgical treatment works about as well.
Decide what's next.
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty.
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
- Nothing. I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
Use the following space to list questions, concerns, and next steps.
Personal Stories
Personal stories about herniated disc surgery
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I injured my back working in the garden a few weeks ago. Based on the symptoms I'm having, my doctor says it's pretty likely that I have a herniated disc. From what I understand, the pain and leg symptoms will probably go away over time, but I can't wait that long. My doctor says that the surgery will probably help me recover a lot faster, even though over the long term it might not make any difference. The short term is what's important to me right now, and I can accept the potential risks, so I'm going ahead with tests and moving forward with the surgery.
Dean, age 39
Surgery has always made me nervous, even though I've never had a bad experience with it myself. I just prefer not to have surgery if I have any other option available. The pain and other symptoms from my herniated disc are getting better, even if it's happening slowly. My doctor said that it is reasonable for me to just keep doing home treatment and take better care of my back. She also says that I'm not risking any serious problems by not having surgery.
Mai-Li, age 57
The pain from my herniated disc is the worst pain I have ever felt. My leg feels like it is on fire. I know that isn't true for everyone who has a herniated disc, but it sure is in my case. I'm willing to try a week or so of conservative treatment, but if there isn't a dramatic improvement, my doctor has agreed to go ahead with plans for surgery.
Jane, age 46
I'm lucky, because my company has allowed me to take a job in another department where I don't have to lift and where I can move around if I need to during the day. If I wasn't able to do that, or if the pain was really bad, I would definitely have had surgery. But this way I can keep working while my back heals on its own. The pain is definitely still there, but it's manageable. I expect that over time I will be able to return to most of my normal work and recreational activities.
Javier, age 43
References
Citations
Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Hu SS, et al. (2006). Lumbar disc herniation section of Disorders, diseases, and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 246–249. New York: McGraw-Hill.
Deyo RA, Weinstein JN (2001). Low back pain. New England Journal of Medicine, 344(5): 363–370.
Atlas SJ, et al. (2001). Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: Five-year outcomes from the Maine Lumbar Spine Study. Spine, 26(10): 1179–1187.
Last Updated:
July 21, 2008- Author:
- Shannon Erstad, MBA/MPH
- Medical Review:
- William M. Green, MD - Emergency Medicine
Robert B. Keller, MD - Orthopedics
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