What are the pros and cons of back surgery for disc problems?  As an Edinburgh osteopath for nearly 30 years, and author of more than one book on back pain I have plenty to say on this subject.

Should you even be considering back surgery for disc problems?

You need to be sure that your pain is due to a disc problem first. It turns out this is not as straightforward as you might think. Most adults over 40 have evidence of disc bulges, herniations, prolapses and degenerative changes. But that’s most adults without any pain!  See the chart below

Table showing incidence of degeneration in lumbar spine in people with no pain

So, if you’re over 40 there’s a 68% chance you’ll have disc degneration, and a 50% chance yo’ll have a bulging/herniated disc, and that’s even if you have no symptoms at all.  I always advise not to put too much store in what the MRI shows.

How can you know that you’re symptoms are due to a disc problem?  Consult someone who specialises in lower back pain and sciatica.

What would be the gold standard for a surgeon considering the pros and cons of back surgery? First he/she would inject the area of the disc with an anaesthetic.  He/she would do this under guided imagery to make sure the injection is going in the right place. If you felt no better, the value of surgery would be questionable.  If you felt better, the injection would be repeated a few days later with saline solution (salt water), without telling you it wasn’t an anaesthetic.  No improvement, then surgery looks more promising.  An improvement after the second injection would mean we know it was the placebo effect, and surgery would be less appealing.

The pros of surgery for disc problems

The research shows that three months after microdiscectomy, people generally feel better than those who chose not to have surgery.  Also, if there’s any hint of a threat to the control of your bladder and bowel, you’d be brave (possibly foolish) to decline surgery.  The nerves to bladder and bowel also pass through the lumbar spine, and can be affected by disc prolapses.

The cons of surgery for disc problems

A review of 133 people having lumbar microdiscectomies (Proietti, Luca et al., 2013) showed that only 6 people had “complications”. Complications means things going wrong.  The table below is taken straight from that study.

  • Transitory neurological radicular deficit may mean weakness or numbness in part of the leg.
  • Deep venous thrombosis is a blood clot, which is a risk of many surgeries.
  • Durotomy is where the membrane around the spinal cord is punctured.
  • Ileus is a blockage in part of the intestinal tract.

Incidence and type of complications in the microdiscectomy group (n=133)

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And it’s worth bearing in mind that a year after surgery people are no better than those who elect not to have surgery.

Summary of the pros and cons of back surgery for disc problems

The upside is that you may well feel better sooner.  The downside is that there are risks, and you’re no likely to feel any better after a year than if you don’t have it.  This is of course a statistical review, and we are all individuals.  Ultimately I’d always recommend consulting a good surgeon and a good non-surgeon who specialises in back pain and sciatica.
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Proietti, Luca et al. “Complications in lumbar spine surgery: A retrospective analysis” Indian journal of orthopaedics vol. 47,4 (2013): 340-5.