When a doctor tells you that you have a herniated disc, the first question that comes to mind for most people is usually, “Do I really need surgery?” For most, the answer turns out to be no. The Cleveland Clinic reports that about 90% of people with a herniated disc get better on their own or with nonsurgical treatment, because the body gradually reabsorbs the disc material and the irritation around the nerve calms down. Unfortunately, a smaller group of patients hit a point where surgery becomes the better option. Knowing where you stand can take a lot of the fear out of the decision.
Read on to learn when it makes sense to wait, what conservative treatments can actually help, and when it’s time to see the best spine surgeon in Los Angeles for minimally invasive surgical treatment.
When Is Herniated Disc Surgery Necessary?
The most serious symptom of needing herniated disc surgery is cauda equina syndrome. This happens when a herniation crushes the bundle of nerves at the bottom of the spinal canal. Signs of cauda equina include:
- Losing control of your bladder or bowels
- Numbness in the area that would touch a saddle
- Sudden trouble starting urination
- Weakness that is getting worse
- Foot drop
- Trouble walking or keeping your balance
- Back pain or sciatica so severe that over-the-counter medications don’t help
If any of these symptoms show up, treat them as a true emergency and go to the emergency room. Surgery to relieve pressure on the nerves usually needs to be performed within 24 to 48 hours to protect long-term function.
How Long Should You Wait Before Considering Herniated Disc Surgery?
The most common advice from spine specialists is to give your body six to 12 weeks of dedicated non-surgical care before talking about surgery, unless red flag symptoms show up. That window matters because the body does a lot of healing on its own during it. The inflammation around a pinched nerve settles, and the disc itself often shrinks back over time. Failed conservative care does not mean a few rough weeks. There are anti-inflammatory medications and orthobiologics that can help relieve back pain during this time.
Conservative Treatments for a Herniated Disc
For most patients, physical therapy is the foundation of recovery. A good physical therapist will help you learn the movements that can take pressure off the irritated nerve, build strength in the muscles that support your spine, and teach you how to sit, stand, and lift in ways that stop making things worse. Additionally, the following conservative treatments can also support healing:
- Over-the-counter anti-inflammatory medicine
- Short rest periods
- Rotating heat with ice
If pain continues after a few weeks but you still have no red flags, an epidural steroid injection can quiet the inflammation around the nerve root long enough for therapy to keep working.
Steroid injections are right for you if you have:
- A smaller herniation
- Symptoms that started recently
- No major weakness
- The ability to stay reasonably active during recovery
Microdiscectomy: The Gold-Standard Surgery for Herniated Discs
When surgery does become the right move, microdiscectomy is a procedure known for being the best herniated disc treatment in Los Angeles. During this procedure, the surgeon makes an incision a little over an inch long, uses a microscope to see the nerve clearly, and removes only the piece of disc that is pressing on it. The rest of the disc stays in place. Most patients go home the same day or after one night. The procedure works best for people with a single-level lumbar herniation, whose leg pain is worse than their back pain and whose MRI clearly matches their symptoms. Most people are walking the same day, back to a desk job in two to four weeks, and cleared for heavier work in six to eight weeks. The main downside to be aware of is re-herniation, which occurs in roughly 5% to 15% of cases.
Endoscopic Discectomy: A Minimally Invasive Treatment for Herniated Disc
Endoscopic discectomy is a modern approach to herniated disc surgery, and it does essentially the same job as a microdiscectomy, but through an even smaller opening. Instead of working through a one-inch incision under a microscope, the best spine surgeon in Los Angeles slides a tube about the width of a pencil between the back muscles, threads in a tiny camera, and removes the offending disc fragment while watching the screen.
Many endoscopic discectomy procedures are done under light sedation rather than full general anesthesia. The patients who tend to benefit most are those with a contained herniation pressing on a nerve from a predictable angle, older patients, or those with health conditions that make general anesthesia riskier. At six months and beyond, the results compare well with what microdiscectomy can deliver.
Finding the Best Spine Surgeon in Los Angeles for Herniated Disc Surgery
Choosing whether to operate on a herniated disc is not a decision anyone should make in a rush, and it is not one you should have to make alone. At California Neurosurgical Specialists, we carefully examine your MRI results and symptoms and build the most conservative treatment plan possible.
Our team is led by Dr. Benet, who has directed the Skull Base and Cerebrovascular Laboratory and completed his residency at the Barrow Neurological Institute, and then added fellowship training in Japan. Today, Dr. Benet teaches the next class of neurosurgeons as an Assistant Professor at UCSF and an Adjunct Professor at Barrow.
Ready to get the best herniated disc treatment in Los Angeles from a spine surgeon who's an expert in the anatomy of the spine and nervous system?
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