I haven’t written much about surgery on this site mainly because most of the people who come here are already looking for an alternative and don’t need much convincing.

That’s my story anyway, and I’m sticking to it.

But as luck would have it, I receive email from time to time asking for my advice concerning microdiscectomy. They usually go something like this…

Dear Dumbass on the Internet,

I have just been diagnosed with a herniated disc at L4, L5 and my orthopaedic surgeon is recommending a microdiscectomy. What should I do?

Sincerely,
Fred

My Usual Response

Dear Fred,

Thanks for your email.

As far as your surgery question is concerned, keep in mind that I’m not a doctor and can’t diagnose, treat or give specific medical advice to individuals. As a journalist, all I can do is write in general terms. My advice is for educational purposes only and should not be construed as a specific recommendation for your situation.

However, having said that — if there is one thing (in terms of back treatment) I’m more opposed to than chiroquacktic adjustments, it’s back surgery. I believe real candidates for surgery to be a rare minority.

Granted, for some people, there is no alternative. Exercise just isn’t going to fix what’s wrong with their back. The good thing is, most orthopedic surgeons are honest and will tell you when they believe that to be the case. I suggest that you always follow their advice.

Sincerely,
Dumbass on the Internet

What I Really Think of Microdiscectomy

Regardless of what terms you put it in; it is essentially a partial amputation. There is no way to get around it. The part of your disc they’re going to remove is never going to grow back.

What you have to ask yourself is, would you agree to that procedure if it were another part of your body? Say a finger or hand, for example.

If you had an injured hand — and there was any chance that it could heal and be rehabilitated — would you take that chance or would you just give up and go for the amputation?

I can’t make that decision for someone else, but I know what my answer would be. They would have to drag me kicking and screaming into the O.R.

Keep in mind that the part of your disc they are going to trim off still has to heal. It will probably take just as long to heal as the bulge itself. It is going to leave the disc thinner and more vulnerable to bulging or rupture in the future. [1] And you’re still going to have to do physical therapy after the surgery.

The only difference is they hope that by removing the bulge, it will stop the sciatica symptoms. It is a symptomatic approach to treating the problem and that is seldom the best choice.

What I Would Do

My advice is to wait at least three to six months. And, according to Dr. Nelson of the Physician’s Neck and Back Clinic, this is also the recommendation of the American Academy of Orthopaedic Surgeons. [2]

In the mean time, try rebuilding your back through physical therapy and see if you can’t rehabilitate your spine and this wayward disc. [3]

Even if you’ve already tried some form of physical therapy and had disappointing results it doesn’t mean that PT isn’t going to work. Just as not all doctors are the same, physical therapists and physical therapy programs can vary widely.

Talk it over with your surgeon and see what he thinks. If he’s okay with it, I would put surgery off for as long as you can.

As always,
Dean

References:

1. Deyo, R.A., and Weinstein, J.N. (2001, February). “Low back pain.” New England Journal of Medicine 344(5), pp. 363-370.

Patients with suspected disk herniation should be treated nonsurgically for at least a month… Even with successful surgery, symptoms often recur after several years.

2. Nelson, B. Disc Syndromes. Physicians Neck & Back Clinics [2005]

Studies show that only about 1 in 10 disc syndromes eventually need surgery so non-operative care is often very successful… In fact, the American Academy of Orthopedic Surgeons recommends delaying surgery for 3-6 months [except for extremely rare conditions].

3. Orthogate, Lumbar Disc Herniation (eOrthopod) Friday, 28 July 2006

Most people with a herniated lumbar disc get better without surgery. As a result, doctors usually have their patients try nonoperative treatments for at least six weeks before considering surgery.