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:
a disk whose edge is bulging into the spinal
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.
- What are the symptoms / signs of a bulging
If this is symptomatic, they are
the same as a those of Herniated
- What is a small tear(s) in the annulus?.
Do these tear(s) typically heal
on their own ?
This is a break in the annulus,
with protrusion of the nucleus through it, a Herniated
The rupture can be sealed by scar tissue, but what really matters is
- Can you determine a herniated
disk with an X ray ?
NO. The disk is a soft tissue that
is barely seen by plain X rays.
- How do I know if I have ruptured another
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.
- At what point should I consider surgery
for a herniated lumbar disk ?
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.
- Can I get a laser surgery
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.
If someone has
a diskectomy, is there relief from the pain?
There should be. That is what
the surgery is intended for.
- What is the success rate
for this operation ?
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.
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
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.
- What could happen if I do
not have surgery ?
- What is the outcome of patients that do not
have surgery ?
- What happens to the herniated disk over the
years if it is not surgically repaired ?
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.
- What exactly are all of
the symptoms that could result from nerve damage ?
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.
- What is the prescribed medicine
for a Herniated Disk ?
Do you know of any natural alternatives to help heal a herniated disk
besides rest and analgesics ?
What is the latest and most effective medicine on the market ?
So far a medicine to cure a
herniated disk does not exist, neither does a natural alternative.
Medicines are prescribed to diminish swelling and pain but not to
cure it (i.e. analgesics and anti inflammatory drugs). Once a disk
has degenerated there is no way to bring it back to normal.
over a long period of time with conservative
treatment cause permanent nerve damage ?
- If the nucleus has oozed
out of the annulus (pressing against the nerves), will conservative
measures help the condition?
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.
- If I lose weight will my
condition improve automatically? I am about 40 lb. overweight
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
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.