Having a surgical consultation for a herniated disc can be a scary experience and statistically often leads to premature or completely unnecessary invasive treatment. Surgical consults are so extremely common when it comes to herniated discs, mostly due to a complete misunderstanding of intervertebral pathologies and unrealistic therapy result expectations from more conservative treatments. As the Editor-in-Chief of this website, I have also experienced a few surgical consultations for herniated discs in my time for various back pain problems. I have a vested interest in this topic, since it not only affects the majority of our readership at some point and time, but it has also affected me and my family personally.
This dialog evaluates the need for surgical consultations for herniated disc patients and provides guidance for patients who are seeking a treatment opinion from a surgical provider. If disc surgery has ever been brought up as a treatment possibility for you, this article is a true must-read.
Herniated discs are most often diagnosed in association with back or neck pain. This is ironic, since there is no scientific proof that herniated discs are in any way inherently painful or even pathological. Regardless, the patient has pain and seeks diagnostic evaluation. Disc abnormalities can be recognized in basic form using x-rays and can be detailed using MRI or CT scan technologies, as well as further analyzed using specialized tests like discograms and myelograms.
Once diagnosed, the vast majority of people will be told that the disc is the cause of their suffering and will be recommended for some type of conservative care. The type of care recommended depends greatly on the background of the diagnostician and their current business model. Chiropractors will virtually always recommend chiropractic adjustments, possibly with the addition of exercises and/or spinal decompression. Physicians will usually suggest pharmaceutical pain management with the addition of physical therapy and eventual epidural injections. Doctors in a combined care practice will recommend trying a bit of everything, since this is their go-to advice for any and all who enter these medical establishments. After all, combined care is a huge money maker and using a one-size-fits-all treatment model by offering a diversity of practices maximizes profit for all involved. Never, ever forget that medicine is a business, now more than ever before in human history!
Conservative care is extremely unlikely to provide a cure for any type of back or neck pain according to most statistics. For particular diagnoses, specific treatments might be both indicated and effective. However, when it comes to herniated discs, the only conservative treatment that can possibly provide any structural change to the disc itself is nonsurgical spinal decompression therapy. All the other possibilities, and there are many, will never provide cures. Since patients will be in care for weeks, months or years, but will not heal, surgery is eventually recommended to those who really want their suffering to end. This basically and eventually accounts for virtually all herniated disc patients who have pain for longer than one year. Some patients try to hold off on surgery as long as possible, while others are anxious to leap right in. However, having a herniated disc, or 2 or 10 (or 12 in my case) and not being recommended for surgery is almost unheard of.
Most patients enter conservative care with the idea that they are being proactive and will be cured by whatever treatment they or their care provider (usually the latter) decides upon. So, they move forward into treatment and are greatly disappointed when their pain does not end. They often try multiple rounds of their first therapy selection before giving up and moving on to something else. With time, many patients try dozens of different drugs and therapy modalities, with each providing a variable degree of efficacy ranging for none to some, but never curing their pain. Typically treatments are more effective when they are first entered into by the patient. With time, the treatment becomes less effectual and the patient moves on to a new option. When the patient or their doctor tires of this revolving door of treatments, they will usually face their first surgical consultation.
Surgeons are great sales people. Most will push their services and flat out inform the patient that of course they did not find a cure using conservative care, since the treatments used are not even curative in nature. They are merely symptom-based practices. This is the complete truth. They then go on to say that surgery is designed to actually cure the problem by treating the disc structure directly. Patients may be given a choice of various procedures to consider, such as discectomy, anterior discectomy, laminectomy, IDET or nucleoplasty or might simply be recommended for a particular procedural path. The patients is so excited at the prospect of actually being cured that they often agree with the surgical plan and place their lives and future physical functionality literally in the hands of this surgeon they met only a few minutes before without asking more than one or two surface questions.
Occasionally, the patient is lucky enough to find a very ethical and conservative surgeon who only recommends surgery for discs that fit very particular parameters. While this is rare, it does happen and provides some comfort to the staff of this website.
I must say that I have personally seen all types of surgeons in my personal experiences. One orthopedist agreed that the whole disc surgery game was a scam for 99% of patients. He said he provides surgical services because that is what people want. I did not want it and he agreed that this was a very good choice on my part. I also saw other surgeons in my time who had the opposite opinion. One physician even threatened me with imminent disability and possible paralysis if I did not go through with his recommendation for double discectomy and spinal fusion at the age of 22 or so. I hope that this doctor received his karmic come-uppance and you can bet that I told him exactly what I thought of his baseless and virtually criminal scare tactics!
The reason why most patients find themselves in these very uncomfortable and frustrating positions is because they simply never took the time or put in the effort to become educated about their diagnoses. Most patients do not know that herniated discs are virtually universal in the adult population and that most are not symptomatic. Pain exists in these people for sure, but might not have any link to the herniated disc at all. However, since the disc was the first diagnostic conclusion offered, the real cause was never pursued and the patient has wasted all this time and money seeking care for a condition that is completely incidental to their pain. No wonder the treatments have been fruitless in providing real or lasting relief! This does not describe every patient, but unfortunately does mirror the profiles of the vast majority of people who write to us with the same questions over and over:
"I have a herniated disc. Do I need surgery?" (Did you actually read anything on our website at all?)
"My surgeon told me I should get surgery. Is she right?" (A surgeon who makes money performing operations recommends surgery… Who would ever think that would happen?)
"What is the best procedure to get for a herniated disc?" (None in most cases)
There are some people who do actually have pathological herniations in their spines. There are even some patients who truly should have surgery, despite the many risks involved. However, these patients account for about 4% and 1% respectively. The "average" person who is diagnosed with a herniated disc does not have any spinal pathology related to the disc and certainly does not need surgery. This is medical fact, supported by countless studies in several sectors of medicine, including physical therapy, sports medicine, orthopedics and neurology.
Our advice for patients facing a surgical consultation is to learn the facts about herniated discs first. Arm yourself with the one thing that will truly help you to make the right choice: knowledge. Additionally, do not rush into anything and ask lots of questions. Make you surgeon commit to their prognosis and put it all in writing. Make them commit to using the least invasive approach and avoiding spinal fusion whenever possible. Most importantly, do not even consider surgery if there is any possible way to avoid it. Outcome statistics for disc operations speak volumes and it is almost all bad news. Even when surgery is needed and all goes well, the chance for re-herniation or continued pain is high and this represents the best case scenario. Be very careful in your decision making!