Surgery for a slipped disc

Surgery is always performed if a slipped disc becomes an emergency. This is the case if it's causing paralysis or if herniated spinal disc tissue is restricting the nerves so severely that the bladder or bowel no longer work properly. But this only happens rarely.

Far more commonly, surgery is performed because long-term symptoms such as severe pain cannot be relieved effectively. The question of whether to go through with surgery is often difficult to answer, though. Surgery may be considered if

• the symptoms are so severe that they have a major impact on everyday life,
• imaging scans such as magnetic resonance imaging (MRI) and the type of symptoms clearly suggest that a slipped disc is the cause,
• the symptoms don’t go away or get worse despite conservative therapies,
• the pain shoots into the leg, and
• the symptoms have lasted for at least 6 to 12 weeks.

Before deciding to go ahead with the procedure, it’s important to carefully weigh the pros and cons together with your doctor. Your personal situation also plays an important role here, including things like your age and overall health, your professional and private life, and your own hopes and expectations for the surgery. Our decision aid can help you to weigh the pros and cons of this kind of procedure.

Various surgical techniques can be used when operating on a slipped disc:

• Open surgery (usually microdiscectomy): Open microdiscectomy is the most commonly performed type of surgery for a slipped disc. It involves removing the damaged part of the spinal disc. The surgeon views the area being operated on through a microscope. Without the use of a microscope, the cut (incision) needed for the procedure has to be made bigger. People who have this open procedure are given a general anesthetic and usually have to stay in the hospital for a few days. Whether you have to stay in the hospital or not (outpatient procedure) depends on things like your age and how long the surgery takes. The risks associated with this surgery include bleeding, nerve damage and infections. A general anesthetic may lead to complications like breathing or circulation problems.
• Endoscopic surgery (also known as minimally invasive or keyhole surgery): This procedure is also common. Especially small instruments are used so that only a small incision in the skin is needed. An endoscope is inserted into the incision in the skin and pushed through to the spinal disc, and then the instruments are fed through to the spinal disc using x-ray monitoring. This procedure can be carried out either with a general or local anesthetic. This endoscopic technique is used to speed up recovery and prevent the formation of scars that may cause problems. But the procedure is associated with risks, too, including bleeding, nerve damage and inflammation.

Experts recommend the removal of spinal disc tissue especially if nerve irritation causes problems in the legs.

Open surgery and endoscopic surgery have been investigated in a number of studies involving participants for whom either surgery or conservative therapy were an option. Most of these studies involved surgery on people who had pain for weeks despite receiving conservative therapy. The studies show the following:

• Surgery can relieve pain and other symptoms such as restricted mobility better than conservative therapy.
• The pain goes away more quickly after surgery.
• After three months, mobility is better following surgery than with conservative therapy.

But after one year, there was no longer any difference in pain between people who had surgery and those who had conservative therapy.

There are no detailed studies on the long-term advantages and complications of surgery. One possible complication is the formation of scars at the site of the operation, which can themselves cause problems such as nerve irritation.

The amount of time needed for paralysis to go away after surgery also depends on how severe it was beforehand. But it can take a while. There is no guarantee that it won’t come back after surgery, either.

Endoscopic surgery is probably as effective at relieving pain and improving mobility as open surgery.

But it is not yet clear whether one type of surgery takes significantly less time than the other, or whether bleeding is less common during endoscopic surgery.

In rare cases, other, more extensive surgery is performed – especially if the vertebrae are also damaged by wear and tear and the spine is no longer stable.

In a procedure called spinal fusion, the surgeon joins the vertebrae above and below the slipped disc together with screws so that they remain firmly in place. Those vertebrae can then no longer be moved. The spinal disc is removed, and the resulting gap between the vertebrae is filled with bone or a titanium implant.

Another option is to put in an artificial spinal disc (implant) that can be used without having to fuse the vertebrae together. The aim of this procedure is to relieve the pain and also avoid the kind of restricted movement that people experience after spinal fusion surgery.

There is hardly any research on the use of these procedures to treat slipped disc. That is why it’s not clear whether they can relieve the symptoms better than conservative therapy. But surgery can lead to complications.

A large number of rehabilitation programs are available for people who have had surgery. Research has shown that rehabilitation immediately after slipped disc surgery (follow-up rehabilitation) can shorten the recovery time and improve mobility.