Herniated disc case: spine surgeon
viewpoint
Conservative care for the herniated disc
The patient has not yet maximized her conservative
care to treat the herniated disc and there would still be some conservative
care options available such as physical therapy
and epidural injections. Oral steroids could
also be tried. However, if she is having a lot
of pain and dysfunction and there has been no
improvement after eight weeks, it would be reasonable
to consider a surgical discectomy. Most symptoms
associated with a disc herniation, if they are
going to heal on their own, will do so within
about six to twelve weeks. If symptoms persist
despite conservative care within this time frame,
then spine surgery might be indicated.
Spine surgery for the herniated disc
A microdiscectomy (microdecompression) surgery is one of the most common spine surgeries
performed and is also one of the most reliable.
There is a minimal amount of morbidity associated
with the procedure, and many patients can return
to their former level of functioning within 1-3
weeks. The success rate is high—at least
90-95% of patients will have good relief of their
leg pain with this type of spine surgery.
Although controversial, some spine surgeons
may also consider doing a spine fusion at the same
time as a discectomy. She has a very degenerated
disc at L5-S1 and a history of other episodes
of back pain. Fusing this segment with surgery
might help prevent other episodes of back pain,
but her episodes have not been severe in the
past and she has had little dysfunction. Fusing
the segment at this time is probably unnecessary
and there is only a 5-10% chance that she will
need a spine fusion surgery in the future. A
spine fusion procedure could add morbidity to
a procedure that normally could be done either
as an outpatient or an overnight stay. Also,
it takes many months for a bone graft that is
used in a spine fusion surgery to heal, and the
patient’s activity might be restricted
during that time period.
By:
Stephen H. Hochschuler, MD
September 14, 2000 |
