Why is herniated disc surgery so ineffective? This is a common postoperative question we receive every week from disappointed patients who chanced it all to go under the knife. We also field this question from thousands of people who are considering a disc-related surgical procedure, but have not decided to go forward due to the lack of efficacy demonstrated in most objective research studies.
For patients who fall into the first category of queries, we wish that we might have had the chance to speak to you before undergoing your surgery. This way, you might have saved yourself the expense and suffering you endured unnecessarily. For patients in the second category, we commend you for doing your research and understanding that surgery is rarely needed for herniated discs, nor is it often effective, especially over extended timelines spanning 7 years or more.
Regardless of which category of reader you might belong to, this essay will clarify why herniated disc surgery provides such generally dismal results. We will examine the factual reasons why surgery is seldom even indicated for disc abnormalities and why it fails even when it is truly necessary.
Misdiagnosis is surely the number one reason why most disc surgery techniques fail to bring about relief. This problem can be traced back to the beginning of the diagnostic process for each patient, when one or more intervertebral abnormalities are mistakenly implicated as being the root causation of symptoms.
Countless respected and objective research studies performed over many decades have definitely demonstrated a complete lack of correlation between the existence of herniated discs and the occurrence of back or neck pain. Doctors and therapists know definitively that herniated discs are not inherently painful or pathological. Herniations themselves are never painful, and can only enact symptomology when they affect a nearby neurological structure, such as the spinal cord or one or more of the spinal nerve roots. Furthermore, it has been shown that the vast majority of herniations do not negatively influence any nerve structures.
All these facts aside, surgery is still one of the most widely used treatments for herniated discs. The disc is probably not the source of pain, but doctors operate on them nevertheless in numbers too large to count worldwide. If the disc is not the source of pain, then it is logical to conclude that pain will remain after the procedure is finished. In the majority of postoperative patients, this is exactly what occurs.
Some patients do enjoy temporary relief, most likely powered by the magnificent placebo effect, but this symptomatic respite is virtually always short-lived. When symptoms return, and they often do, they are typically worse than ever, forcing some postoperative patients into complete functional disability when they had hoped so desperately for a cure.
Our statistics show that over 90% of patients who undergo surgical intervention for a herniated disc do not require invasive care. In the remaining 10% of cases, some patients do actually require surgery, while others can not be definitively placed into either category.
Even for patients who have a definitive diagnosis showing the disc to indeed be the source of their pain, surgery is never a sure path to travel. We see many patients whose disc issues are definitely creating spinal stenosis, foraminal stenosis or chemical radiculitis, yet operative interventions also fail to provide relief. Why then, do these procedures disappoint so frequently?
In a minority of cases, the disc condition is not resolved during surgery. The actual operation fails due to complications, unforeseen circumstances or iatrogenic error. While this occurrence is the least common scenario, it still spoils thousands of surgical endeavors each year.
More commonly, the procedure will succeed in its objective and bring about total or almost total relief over a timeline of 1 week to 7 years. However, pain recurs and might be worse than the first time around in many instances. The reason why this occurs is usually a re-herniation of the original surgical site (most common with discectomy) or herniation of a nearby disc structure, often related to surgical trauma or surgically-induced degeneration (most common after spinal fusion).
Many less invasive types of disc surgery, such as discectomy, IDET and nucleoplasty can further weaken the damaged intervertebral structure, creating the ideal circumstances for a recurrence of disc prolapse or catastrophic degenerative intervertebral collapse in the future. Meanwhile, spondylodesis surgery is proven to drastically deteriorate neighboring vertebral and intervertebral levels due to exponentially increased stresses caused by the fusion. Both of these scenarios often lead to multiple surgical treatments over extended timelines and a markedly increased chance of suffering functional disability.
After reading the statistics concerning herniated disc surgeries we are surprised that virtually any patient chooses to undertake the risks for the minimal chance of a potential reward. That is until we consider the utter agony of back or neck pain and the psychoemotional effects perpetrated against the poor victim. People will do anything to be free from the type of suffering involved in chronic dorsalgia conditions. They will take chances against logic and probability with the hope that they might be one of the lucky few who do enjoy true cures from even the most barbaric of surgical interventions.
Speaking of cures, we must mention that some patients do actually require surgery and are best served through invasive treatment. When the diagnosis is sound and the procedure goes well, some of the patients enjoy true relief that may last for a very long time. These patients are not typical, but it is possible to become one of them. If you are considering disc surgery, better your chances of a successful outcome by doing everything you can to stack the odds in your favor:
First be certain that the disc is the actual origin of symptoms. This is the step where most patients go awry, ending up in surgery for a disc "problem" that is actually a complete nonissue.
Next, research your many procedural options for disc surgery and choose the one that can best accomplish the surgical goal with the least amount of trauma to healthy tissues. Minimally invasive care is always the way to go when these techniques are available.
Do everything possible to avoid spinal fusion, as this is the most complication-ridden of all spinal surgery practices. Instead, if the spine needs stabilizing after dramatic discectomy, consider artificial disc replacement or a less damaging form of surgery, such as nucleoplasty or IDET, when indicated.
Carefully select your spinal surgeon, since this person will literally hold your life and future functionality in their hands. Not all surgeons are created equal in skill or results, so shop smart and take your time.
Finally, do everything possible to be sure that you are otherwise healthy and ready to commit to the rehabilitation process immediately following your procedure. A positive mindset is one of the most important factors to take into surgery and is certainly the most important postoperative factor towards making a complete recovery.