Surgery for Herniated Discs and Sciatica

Should I Have Surgery or Should I Wait?

Question: I have two herniated discs that have caused pain to radiate down my legs to my feet. I have tried everything from chiropractic and acupuncture to physical therapy and medications. But the pain is just getting worse. How does a doctor decide if surgery is the answer? And how long is too long to wait to have surgery?
— Lettsworth, LA
Modern Operating room with imagery equipmentAnswer: I'm sorry to hear that chiropractic, acupuncture, physical therapy, and medications have not worked to reduce your sciatica. Because these treatments haven't worked for you, surgery is certainly a consideration in your case.

With a herniated disc, it's somewhat common to develop back pain and/or sciatica (which is another name for that pain that's radiating down your legs), so you're certainly not alone. Fortunately, most patients with herniated discs are successfully treated without ever needing surgery.

Before making the decision to have surgery, you may want to consider these 2 treatments options for herniated discs and sciatica.

  • Exercise: Aerobic, strengthening, and flexibility exercises can help ease your pain. For example, yoga and Pilates may be effective because they help strengthen your core and other muscles. But some exercises can make sciatica worse. Work with a physical therapist or certified personal trainer who can teach you appropriate exercises to reduce your sciatica.
  • Spinal injections: A spinal injection is an injection of medication (usually a combination of a numbing medication and a steroid) into the space around an irritated nerve. It can help reduce pain and delay surgery—or avoid it altogether. Examples of injections are nerve root blocks and epidural steroid injections. For people who mainly have pain without other symptoms (eg, numbness, weakness), spinal injections can be incredibly effective.

If pain is your only symptom—which it sounds like it is—it is usually safe to delay surgery. In fact, most herniated discs in the lumbar spine (low back) will actually improve without ever requiring surgery.

Surgery is usually recommended for patients who have the following:

  • continuous nerve damage that causes numbness and weakness
  • intense pain that cannot be successfully treated using non-surgical techniques

As for deciding whether you should have surgery, you and your doctor will make that decision together. I typically explain to my patients that a waiting period is often beneficial. I usually try to wait between 6 to 12 weeks before recommending surgery for a herniated disc unless the patient has severe pain or nerve damage.

If nerve damage has occurred, you may notice numbness or weakness in your legs, or in severe cases, loss of bowel and/or bladder control. In this case, you may need surgery to stop further nerve damage. If you have signs of nerve damage, including numbness, weakness, or loss of bowel and bladder function, call your doctor immediately.

There is no definite period of time that is too long to wait to have surgery if pain is your only symptom. However, if your sciatica caused by your herniated discs has been going on for many weeks and months and non-surgical treatments haven't worked, surgery may be a good option for you.