Herniated Lumbar Disks
Frequently Asked Questions ( FAQ )

These are selected questions from the readers of these pages and will be updated as new messages are received.

Please take into consideration that I can not answer specific matters related to a patient that I have not examined and whose X-rays or other studies I have not seen. Most of the technical terms used here are explained en the related pages in this site.

The questions are organized in 4 groups:

Herniated disk:

Surgical Management:

Conservative Management:

Recurrent Herniation

Herniated disk:

It's a disk whose edge is bulging into the spinal canal ,where the nerves traverse to the foramina. This can be produced by swelling of the nucleus, diminishing of the intervertebral space, etc. In most cases is asymptomatic and it is merely a radiological finding. But if this bulge is big enough it will impinge the nerves, giving the symptoms and signs of a herniated disk and for practical purposes it has to be considered as such.

If this is symptomatic, they are the same as a those of Herniated Disk.

This is a break in the annulus, with protrusion of the nucleus through it, a Herniated Disk. The rupture can be sealed by scar tissue, but what really matters is the nerve.

NO. The disk is a soft tissue that is barely seen by plain X rays.

If this is the first time that you have symptoms, it is most probable that only one disk is responsible for them. If you are talking about recurrent symptoms, after good results from surgery or conservative measures, the only way to determine it is through a careful clinical examination and a new MRI. Recurrent disks are discussed elsewhere on this page.

Surgical Management:

This has to be discussed with your doctor. Usually there is given a period for conservative management, but the length of this will depend on the intensity of the pain and the associated neurological signs. Personally I believe that if the pain is bearable with analgesics and anti inflammatory drugs, a 4 weeks trial is a good lapse. I don't like to wait more than a week if there is muscle weakness. If there are bladder problems the surgery has to be done immediately.

• This will have to be discussed with your doctor. The annulus has to be intact, if there is a rupture in it and a part of disk is going out through it, you need open surgery. This usually can be determined upon examination of the MRI.

• It varies from surgeon to surgeon and from place to place. A good average is over 80% and this applies for conventional and laser surgery. The patient plays a very important role in success. Overweight and bad habits are against good results.

• Since there is nothing going in to replace the disc, will I face further surgery in a couple of years to fuse the vertebrae?

  Normally not, even though the inververtebral space diminishes the alterations to the stability of the spine are minimal; remember that the surgery does not remove the whole disk. The fusion does not depend on a herniated disk but on the condition of the spine, the degenerative changes and the stability it shows.

• What are the risks involved in the classical surgery and how effective is it ?

  Besides those inherent to every surgical procedure, the most common are nerve damage and infection, but both are less than 1% in expert hands. When there is nerve damage one has to remember that the patient is not going to be paralyzed, it is only one nerve that will be affected, this will produce weakness or numbness on its territory. There can be some other rare complications of bladder, sexual or bowel function, as well as of bleeding.

• What are the risks of Laser Surgery ?

  The same as above, but very unlikely.

Conservative Management:

The symptoms can stay permanently. If it is pain, it will depend on your tolerance to it that you'll be able to have a good life. If there is muscle weakness it will probably affect your walking. There are some people who recover completely after some months, the problem is that there is no way to know who they are going to be. In the latter cases it has been observed that the body absorbs the disk material, or it calcifies and diminishes to a size that does not produce nerve compression.

It depends on the nerve that is having the compression, which would affect the muscles it supplies, as well as the sensibility of the skin and tendons (your doctor could tell you about that). Usually walking is affected, most commonly there will be weakness to tiptoe or foot drop. There could also be urine retention, loss of sphincter control, impotence, etc.

• Will waiting over a long period of time with conservative treatment cause permanent nerve damage ?

There is always a chance. This is why conservative treatment is imperative before thinking of surgery. What might happen is that the extruded disk material is swollen and with rest and anti inflammatories its volume can diminish and the pressure over the nerve disappears.

• It will definitively improve. To what extent it's difficult to say, it depends on the size of the herniated disk and the condition of your spine. If surgery has to be performed, overweight will definitively increase the recovery time and as well as the possibility for a recurrent disk herniation.

• Can a hernia appear in the same place ?

  YES. Remember that a diskectomy only removes part of the nucleus. Generally speaking, a person that has had a herniated disk, operated or not, has 10 times a higher chance of having a second disk herniation than the rest of the population.

• Can a herniated disk be operated again ?

  Yes, and the same indications as for a first herniated disk apply in respect to conservative management and the decision for surgery.

• What are the possibilities of improvement after a second operation ?

  We mentioned that on the first operation the chance of success is usually over 80%, in the case of a second operation it closes to 70%. The scar tissue surrounding the nerve plays an important role here.

• What are the risks of a second operation ?

  If it is after a laser diskectomy, the risks are the same as those of the first operation. If it is after an open classical diskectomy the surgeon has to be extremely careful because the nerve root can be enclosed in scar tissue.

• Can laser be used to operate on a recurrent disk ?

  If it is a contained disk (no break in the annulus), it is possible. After open surgery some people have done it, but generally it's not recommended because the annulus has been disrupted on the first operation, situation that increases the risk for nerve damage as one can't tell how close the nerve is to this opening. Also the laser woks dehydrating the tissues and the scars contain very little water.