By Brett Sears, PT 

 Medically reviewed by Stuart Hershman, MD

 Fact checked by Heather Mercer

Herniated disc surgery is an operation in which a spinal disc that has herniated is cut away from a nearby nerve. The procedure is typically performed by an orthopedic or neurological surgeon. The goal of herniated disc surgery is to relieve pain and restore normal motion when a disc herniates, or is pushed out of place, and is compressing a spinal nerve.

What Is Surgery for a Herniated Disc?

If you have low back pain, sciatica, or cervical radiculopathy, a herniated disc may be causing your problem. This occurs when the gel material inside a spinal disc pushes out of place and compresses a nerve. This is also known as a bulged, slipped or ruptured disc.1

Typically, herniated discs occur in adults, so children are not considered for this procedure. Most often, the procedure is performed as an elective planned operation. In severe cases of spinal nerve compression causing acute paralysis, an emergency surgery may be preformed.

There are different types of surgery for herniated discs. These include:2

• Laminectomy

• Foraminotomy

• Discectomy

• Spinal fusion

The specific surgery that is performed for your herniated disc will be determined by your healthcare provider and will be based on a variety of factors including the location and size of the herniated disc, the bony anatomy around the disc, and your medical history and state of health. Be sure to speak with your practitioner to understand which surgery you will be having.

Various Surgery Techniques

There are different surgical techniques used to relieve spinal and nerve pain due to a herniated disc. These include:

• Anterior cervical discectomy and fusion: This procedure is performed to excise a herniated disc in your neck. A small incision is made in the front of your neck and the herniated disc is removed. A small metal spacer is placed in the location where your disc was, and screws are inserted to fuse your bones together.3

• Standard open posterior approach: This procedure involves making an incision in your back, retracting your spinal muscles away from your bones, and cutting away the disc material from the spinal nerve.

• Minimally invasive surgery: During minimally invasive surgery for herniated disc, a tiny incision is made in your back. A special camera and microscope are inserted in your back to visualize your herniated disc and spinal nerves. Then, specialized tools are used to cut away disc material from the nerves.

Usually, smaller incisions during surgery mean less pain, less risk of infection, and less risk of blood loss.4

While most people prefer minimally invasive spine surgery, your surgeon may prefer to perform an open procedure to fully visualize the surgical field. You must discuss your expected procedure with your surgeon to ensure you understand what to expect with your herniated disc surgery.

Contraindications

There are some people who should not have herniated disc surgery. Contraindications to the procedure may include:

• Those with an uncertain diagnosis

• People with minimal pain

• People with mental impairments who cannot make sound decisions regarding their care

The decision to have herniated disc surgery is one that should be taken seriously; your surgeon should have a frank discussion with you regarding the procedure, risks, and potential outcomes of the operation.

Potential Risks

No surgery is without risk, and there are risks associated with surgery for a herniated spinal disc. These risks may include:56

• Excessive bleeding

• Failure to adequately reduce your pain or worsening of your condition

• Infection

• Nerve damage

• Cerebrospinal fluid (CSF) leak

Rest assured that most people who have spinal surgery make out just fine and recover without complications.5 Understanding the risks associated with the procedure can help you make an informed decision about having surgery.

Purpose of Surgery for Herniated Disc

The purpose of the surgical procedure for a herniated disc is to relieve pressure off a spinal nerve caused by a disc that is compressing it. You can imagine spinal discs as being tiny jelly donuts that are between your spinal bones.

Sometimes poor posture, heaving lifting,7 or normal wear and tear weakens the wall of the disc, and the jelly-like inner material (nucleus pulposus) pushes out of place. When this occurs, the jelly presses up against a spinal nerve.

This may cause pain, limited motion, or weakness to occur. Herniated disc surgery relieves this pressure, and can help you recover pain free mobility, flexibility, and strength.

Symptoms of a herniated disc may include:1

• Back pain

• Neck pain

• Leg or arm pain

• Weakness in your arm, hand, or leg

• Difficulty sitting, standing, or walking

• Changes in your bowel or bladder function (a serious condition known as cauda equina syndrome)

If you suspect you are having a problem with your spine, you need to see your healthcare provider to assess your condition. Your practitioner may order a magnetic resonance imaging (MRI) test which will show the position of your spinal bones, nerves, and discs.

If a disc is displaced or herniated, it will show up on the MRI test and surgery may be recommended to relieve your pain and improve your mobility.

How to Prepare

Prior to having herniated disc surgery, you must attempt to manage your pain conservatively. That means working with a physical therapist or chiropractor, attempting specific exercises to help push the disc away from your spinal nerves, and be as active as possible.

If conservative measures fail to produce results, you may require surgery, and you may need to prepare. Things that you may be required to do to prep for surgery may include:8

• See your doctor for a physical and lab work.

• You may need to have your heart checked to ensure you can tolerate surgery and anesthesia

• Confirm if there are any medications you need to stop taking before the surgery

• Make sure your insurance company will cover the cost of surgery

• Arrange for a trusted family member or friend to help you after surgery

• Eat a healthy diet and get plenty of exercise before the surgery to optimize your recovery.

• Quit smoking

Of course, be sure to follow your surgeon's advice and recommendations when preparing for surgery. Ask any questions you may have, and be sure to understand what should be done to have an optimal outcome from surgery.

What to Expect on the Day of Surgery

On the day of your surgery, you will arrive at the hospital or surgical center at your assigned time. You will likely change into a hospital gown, nursing staff will check your vitals such as heart rate and blood pressure, and an intravenous (IV) line will be started. Your surgeon will meet with you and discuss your surgery with you.

Then, the anesthesiologist will use medication to make you drowsy and ensure you cannot feel the pain of the surgical procedure. You will be brought to the operating room, and the surgery will be performed. When you awake from anesthesia, you will likely be in the recovery area, and the nursing staff will care for you.8

After surgery, you may be given small amounts of food and water or juice, and medication will be administered to ensure you are comfortable. Most people spend one evening in the hospital, but more recently, outpatient spinal surgery is taking place. In that case, you will be able to return home that same day to begin your recovery.9

Recovery

Recovery from herniated disc surgery begins immediately after the procedure. Most people are encouraged to walk a bit after surgery, and you can expect to move gingerly for about five or six days after the operation. You may be advised to sit with proper posture and avoid heavy lifting, twisting, or bending after the surgery.10 You may also be required to wear a brace.8

Many people benefit from performing gentle exercises for spinal range of motion, flexibility, and strength after the operation. Working with a physical therapist may be indicated.11

Most people recover from herniated disc surgery in about four to eight weeks. Your specific course of recovery may be more or less depending on the severity of your condition.

Follow-Up Care

You will likely visit with your surgeon immediately after your operation. They will explain to you (and your family or anyone who you choose) how your surgery went and if there were any complications during the procedure. Most people go home the day after surgery.

After about one week, you will follow up with your surgeon. They will examine your incision, and remove sutures provided that things are healing properly. Your surgeon may also ask about your pain level, and medication may be prescribed to help you maintain good pain control.12

You may be referred to physical therapy after surgery to aid in your recovery. You can also expect to visit your surgeon at regular two or three week intervals for a few months. Your surgeon will monitor your progress and ensure that things are going according to plan.

Sources

American Association of Neurological Surgeons. Herniated disc.

Columbia University Neurosurgery. Laminectomy, Laminotomy, Foraminotomy, Laminoforaminotomy.

O'Neill KR, Wilson RJ, Burns KM, et al. Anterior cervical discectomy and fusion for adjacent segment disease: Clinical outcomes and cost utility of surgical intervention. Clin Spine Surg. 2016;29(6):234-41. doi:10.1097/BSD.0b013e31828ffc54

Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;11(11):CD001546. doi:10.1002/14651858.CD001546.pub4

Reis RC, Oliveira MF de, Rotta JM, Botelho RV. Risk of complications in spine surgery: A prospective study. Open Orthopaedics Journal. 2015;9(1):20-25. doi:10.2174%2F1874325001509010020

Brouwer PA, Brand R, van den Akker-van Marle ME, et al. Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: A randomized controlled trial. The Spine Journal. 2015;15(5):857-865. doi:10.1016/j.spinee.2015.01.020

Fares MY, Fares J, Salhab HA, Khachfe HH, Bdeir A, Fares Y. Low back pain among weightlifting adolescents and young adults. Cureus. 2020;12(7):e9127. doi:10.7759/cureus.9127

Johns Hopkins Medicine. Your guide to spine surgery - Johns Hopkins Medicine.

Yerneni K, Burke JF, Chunduru P, et al. Safety of outpatient anterior cervical discectomy and fusion: A systematic review and meta-analysis. Neurosurgery. 2020;86(1):30-45. doi:10.1093/neuros/nyy636

Hartford Healthcare. Post-operative instructions: Lumbar spine surgery.

Mader M, Brady J, Deily S et al. The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: A systematic review. J Neurosurg Spine. 2017 Jun;26(6):694-704. doi:10.3171/2016.10.SPINE16627

The University of Wisconsin Health. Home care instructions after lumbar laminectomy, decompression or discectomy surgery.

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.