When is it time for lumbar disc herniation surgery and what does it involve?

Dr. Sandro LaRocca MD of New Jersey Neck & Back Institute, P.C.

The vertebrae at the base of your spine are called lumbar vertebrae. You have five lumbar vertebrae and your surgery will name which ones surround the damaged disc. For example, you may have been told you “need a discectomy at L4-L5.”

You may hear your surgeon say that your disc herniation was due to “degenerative disc disease.” Degenerative disc disease can cause a variety of problems, with herniation being one of them, and may require a variety of solutions in addition to discectomy.

A lumbar herniation is when a disc has moved from its correct spot between the vertebrae to protrude or extend on one side or another, putting pressure on the nerve root. Frequently a lumbar disc herniation will cause pain to radiate down one or both legs, a symptom described with the medical term “radiculopathy.”.

What does it mean that I have been diagnosed with a sciatica or a lumbar disc herniation?

Dr. Sandro LaRocca, director and founder, New Jersey Neck & Back Institute

In the simplest terms, it means that a disc or several between the vertebrae in your lower back region ruptured or tore, and the soft inner jelly-like layer has bulged out of the harder outer edge.

This also is sometimes erroneously called a “slipped disc,” though there is no actual “slipping,” and the appearance is more of a protrusion of the disc.

The disc rupture may result in lower back and leg pain called radiculopathy (pain that radiates down one or both legs also is called sciatica). Compression on a nerve root by the ruptured disc may result in a lumbar radiculopathy characterized by leg pain, numbness, tingling or even weakness in the distribution of that nerve down your leg.

Disc herniation and pain from radiculopathy can be due to aging, but also can be caused by sports, exercise or lifting injuries. It is the most common source of back pain, which affects an enormous percentage of adults, and it is the most common reason for reparative surgery.

Why is surgery a good solution?

Sometimes disc herniations will resolve themselves if they are not severe. Other times the radiculopathic pain and neurologic dysfunction can subside with non-surgical methods, such as physical therapy, chiropractic manipulation and spinal injections.

Often, lumbar disc herniations also can be seen on imaging but may not always cause symptoms. However, many disc herniations will continue to cause chronic radiculopathy and lower back pain or dysfunction that will persist until the physical structure or ruptured disc is surgically altered to alleviate the pain.

Surgery is recommended for severe/incapacitating pain, nerve dysfunction or when all the other treatments have failed and the herniation looks likely to be alleviated with surgery. The disc herniation surgery seeks to eliminate the root cause of pain and nerve dysfunction and improve the quality of life for the patient.

What does the lumbar disc herniation surgery do?

Surgery for disc herniations is called a “discectomy,” which means essentially removing the portion that is protruding and irritating the nerve root. The lumbar spine does not contain the spinal cord but does contain the spinal nerves that branch out of the spine to form the sciatic nerve.

Unlike a disc herniations elsewhere in the spine, surgery for a lumbar disc herniation is frequently performed through small incisions on the back. The injured disc or discs are removed, relieving the pressure from the spinal nerve(s), thereby alleviating symptoms.

What are the outcomes of lumbar disc herniation surgery?

The majority of disc herniation surgeries result in significant relief from pain and dysfunction for the patient. If the patient is properly diagnosed and fits the criteria for the discectomy procedure, the outcomes are generally excellent, assuming the patient participates in the right aftercare procedures. Each patient is unique and we will discuss your particular case with you in great detail as well as what your expectations should be.

What is it like after the surgery and what does the recovery entail?

Lumbar disc herniation surgery is not a one size fits all, but a minimally invasive surgery with a small incision usually means you may have the surgery in the morning and go home that evening or the next morning, depending on how involved the surgery is.

You will be given medication to help manage any post-surgical pain, which your surgeon will discuss with you in great detail. A back brace may be prescribed for comfort for a time after the surgery and outpatient physical therapy will help in pain reduction, conditioning and return to normal functioning.

Most discectomies do not involve major convalescence and patients do not need excessive time off from work (though several days are generally needed). Your surgeon will discuss your activity restrictions, which are typically temporary while you heal.

Generally, patients will not be able to lift anything heavy for a few weeks or engage in similar strenuous activity. Therefore, those patients whose jobs involve strenuous activity such as construction will need more time off than someone who is seated all day. Your doctor will develop a detailed return-to-work and activity plan for you.

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*We are located in New Jersey, USA and do not provide medical advice via email or phone. We do not accept Medicare or Medicaid, however we do participate with commercial insurance as an out of network provider.

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