Should Young Patients with Herniated Discs Consider Surgery?

Is surgery recommended for young individuals with a herniated disc?

I read your response, Doctor, regarding lumbar disc herniation.
You mentioned that it can compress the sciatic nerve, causing symptoms not just in the lower back but also pain in the buttocks that radiates down the back of the thigh and calf to the sole of the foot, along with numbness.
You noted that symptoms may worsen when coughing or sneezing, and that performing knee extension can produce an electric shock-like sensation from the buttocks to the foot.
I recently had an MRI, and the doctor confirmed a herniated disc at the L5 level and strongly recommended surgery.
However, I would like to ask: if I have all the symptoms you described and often experience severe pain at night that prevents me from sleeping, my family is hesitant about surgery due to concerns about potential complications.
Is it possible to recover through physical therapy or chiropractic treatment without surgery?

A Cheng, 20~29 year old female. Ask Date: 2017/03/09

Dr. Shi Guozheng reply Orthopedics

Conservative treatment for six weeks is recommended, and if there is no improvement, surgery is suggested.
The outcomes of the surgery are quite favorable, the risks are low, and recovery is typically rapid.

Reply Date: 2017/03/09

More Info

When considering surgery for young patients with herniated discs, several factors must be taken into account, including the severity of symptoms, the impact on daily life, and the potential risks and benefits of surgical intervention. In your case, it appears that you are experiencing significant pain and discomfort, particularly with symptoms that radiate down your leg, which is indicative of nerve compression due to the herniated disc at the L5-S1 level.

Herniated discs can lead to a condition known as sciatica, where the herniated material presses on the sciatic nerve, causing pain that radiates from the lower back down through the buttock and into the leg. This pain can be exacerbated by certain movements, such as coughing or sneezing, and may be accompanied by numbness or weakness in the affected leg. The fact that you are experiencing severe pain that disrupts your sleep is a significant concern and suggests that your condition may be affecting your quality of life.

In young patients, the decision to undergo surgery is often influenced by the degree of pain and functional impairment. If conservative treatments such as physical therapy, medication, or alternative therapies (like acupuncture or chiropractic adjustments) have not provided relief, surgery may be considered. The goal of surgery, typically a discectomy or laminectomy, is to relieve pressure on the affected nerve root, which can lead to a significant reduction in pain and improvement in function.

It's understandable that you and your family may have concerns about the risks associated with spinal surgery, especially given your young age. However, it's important to note that many patients, including younger individuals, undergo successful spinal surgeries with minimal complications. The risks of surgery can include infection, bleeding, nerve damage, and the possibility of needing further surgery in the future. However, these risks must be weighed against the potential benefits of alleviating debilitating pain and restoring function.

If you choose to pursue conservative treatment options, it's essential to have realistic expectations. While some patients do experience improvement with physical therapy and other non-surgical treatments, others may find that their symptoms persist or worsen over time. In cases of significant nerve compression, delaying surgery can lead to chronic pain or even permanent nerve damage.

In summary, if your symptoms are severe and significantly impact your daily life, it may be worth considering surgical options despite the concerns. Consulting with a spine specialist who can review your MRI results and provide a comprehensive assessment of your condition is crucial. They can help you understand the potential outcomes of both surgical and non-surgical treatments, allowing you to make an informed decision that aligns with your health goals and lifestyle. Remember, the ultimate aim is to relieve pain and improve your quality of life, and sometimes surgery may be the most effective path to achieve that.

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