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Q: Do all herniated disks require surgical treatment?

Posted August 27, 2014 in Advice Column, Waukee

A: The simple answer is no, not at all. The majority of patients do not require surgical treatment for disk herniation. While the pain and numbness some patients experience with herniated disks (often referred to as HNPs) warrant invasive treatment including surgery, patients with “only” pain and numbness may allow those symptoms to be their guide in considering treatment options.

Muscle weakness due to acute or subacute nerve impingement is a relative indication for surgery. Some studies indicate that strength is more likely to improve if the impingement is relieved within the first three to four months of onset. Surgical treatment is urgent and mandatory only in a condition called cauda equine syndrome (CES). CES occurs with marked nerve impingement and involves bowel and bladder impairment. Treatment options for HNPs include time, rest, activity restrictions, medications, epidural steroid injections and surgery. The vast majority of HNP patients treated surgically undergo a partial discectomy (removing the herniated portion of the disk) rather than a fusion, which is a much greater surgery in which the vertebrae are made to grow together by placing bone graft and metal implants, in addition to relieving nerve pressure.

Information provided by Dr. Lynn Nelson, Spine Surgeon, Des Moines Orthopaedic Surgeons, 6001 Westown Parkway, West Des Moines, (515) 224-5217.

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