Is surgery always needed for a slipped disc?
Most people improve with rest, medicines and physiotherapy. Here is when surgery is considered.
Being told you have a slipped disc can sound alarming, especially when the pain runs down your leg. The reassuring part is that most people get better without an operation. This is what I explain to patients in clinic.
What a slipped disc is
Between the bones of your spine are soft, rubbery cushions called discs. With age or strain, the tough outer layer of a disc can tear, and some of the softer centre bulges out. If it presses on a nearby nerve, you can feel pain, tingling or numbness in the back and down the leg (sciatica), or in the neck and down the arm.
You may also hear it called a disc prolapse or a disc herniation. These all describe the same problem.
What usually happens
For most people the pain is worst in the first two weeks and then settles gradually over six to twelve weeks. The body often shrinks the bulging part of the disc on its own, and the swelling around the nerve calms down. An MRI scan can look worrying even when the outlook is good, so I always read the scan together with how you are and how you are changing.
What helps in the meantime
- Keep moving within comfort. Short walks several times a day are better than lying in bed.
- Take pain relief as advised by your doctor. Some medicines help nerve pain in particular.
- Start physiotherapy once the worst pain eases, to strengthen the muscles that support your spine.
- Avoid heavy lifting and long periods of sitting for a few weeks.
- If leg pain stays severe, an injection around the nerve can sometimes calm it while the disc settles.
When surgery is considered
Surgery is an option, not a failure of treatment. I usually discuss it when:
- Leg or arm pain lasts more than six to eight weeks despite good treatment, and it stops you working, sleeping or walking
- There is weakness in the foot, leg or hand, or the weakness is getting worse
- The pain cannot be controlled even with strong medicines
Even then, the decision is yours, made with all the information in front of you.
Go to an emergency department now if you have
- Numbness in the groin, buttocks or inner thighs
- New difficulty passing urine, or loss of bladder or bowel control
- Weakness in both legs that is getting worse
These can be signs of cauda equina syndrome, where a large disc presses on the nerves at the base of the spine. It needs an operation within hours.
What the operation involves
The usual operation is a microdiscectomy. Through a small cut, and using a microscope or an endoscope (a thin camera), the surgeon removes only the piece of disc that is pressing on the nerve. The rest of the disc stays in place. Most people walk the same day, go home within a day or two, and return to desk work within a few weeks. Like any operation it has risks, and I go through them with you before you decide.
Questions worth asking
- Is there any weakness, and is it changing?
- What is likely to happen if I wait a few more weeks?
- Which operation would you suggest, and why?
- When can I return to work, driving and exercise?
If you have been told you need surgery and feel unsure, a second opinion is always reasonable. Bring your scans and reports, and we can go through them together.