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I Have A Herniated Disc In My Back!

As a neurosurgeon I frequently see patients with this complaint and understandably they are quite concerned. I want to allay some of the anxieties and concerns regarding herniated discs.

The vast majority of herniated discs (89%) occur in the lower back, 10% occur in the neck, and only 1% occur in the midback. Herniated discs are most frequently symptomatic in the lower back, where symptoms are caused when the disc herniation puts pressure on nerves in the spinal canal. Symptoms consist of lower back pain which shoots down into the leg and depending on which disc is involved, may even go into the foot. Pain may be worsened by coughing or sneezing, and may be relieved upon flexing the knee and thigh. There may also be associated numbness and weakness of the affected leg.

Over 85% of patients with acute disc herniation will improve without surgical intervention in an average of 6 weeks. These patients may be managed effectively with various treatments including education and counseling, analgesic medication, muscle relaxants, physical therapy, acupuncture, and injections. Indications for surgery include but are not limited to, uncontrolled pain, progressive weakness, or unwillingness on the patient’s behalf to wait for symptom resolution.

The surgical procedure to treat a lower back disc herniation is called a lumbar discectomy. It is one of the most frequently performed operations by a neurosurgeon. It involves a skin incision placed along the midline of the back, followed by removal of a small amount of bone to expose the compressed nerve and herniated disc. The surgeon then gently navigates around the nerve to gain access to the herniated fragment, which is then carefully removed, relieving the pressure on the nerve root. Patients are admitted on the day of surgery and may be discharged later that day, or the morning after.

In summary not all herniated discs cause symptoms and not all symptomatic herniated discs require surgery. It is important to be assessed by a neurosurgeon who can determine what treatment if any is necessary.