How Bad Does a Herniated Disc Have to Be for Surgery?

A herniated disc does not always cause symptoms. When symptoms occur, they can depend on which disc is affected and how large the herniation is, and may include: 

• Low back pain
• Herniated disc in the lower back (lumbar spine)
  • Tingling, pain, burning, numbness, or weakness that spreads down one leg and sometimes into the foot 
    • Usually only one side is affected
    • Pain may be described as sharp and electric shock-like
    • Straightening the leg can worsen the pain
    • Pain may be more severe when standing, sitting, or walking
  • Sciatica/radiculopathy 
• Herniated disc in the neck (cervical spine) 
  • Dull or sharp pain in the neck or between the shoulder blades
  • Pain that radiates down the arm to the hand or fingers 
  • Numbness or tingling in the shoulder or arm
  • Pain may increase with certain positions or movements of the neck

In some cases, excessive strain or injury may cause a herniated disc, but the main cause of a herniated disc is natural degeneration that occurs with aging. In some people even a minor strain or twisting movement can cause a disc to rupture. 

Some people are predisposed to disc problems and herniated discs may run in families.

In general, a patient history and physical examination is all that is needed to diagnose a herniated disc because most people who have symptoms of a herniated disc will recover on their own. 

Doctors will usually wait until a person has symptoms for at least 4 to 6 weeks before ordering tests. The reason for this is that the treatment is the same, no matter what the test might show. In cases where tests are needed, they may include imaging tests such as: 

• Magnetic resonance imaging (MRI) scan
• Computerized tomography (CT) scan

Herniated discs often go away on their own and conservative treatment may be all that is needed. 

Conservative treatments include:

• Over-the-counter pain medications 
  • Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve)
  • Acetaminophen (Tylenol) 
• Muscle relaxants
• Injections of medicines that numb the back 
• Steroid injections
• Physical therapy to learn strength and stretching exercises
• Spinal manipulation by a physical therapist or a chiropractor 
• Acupuncture
• Massage
• Exercise and staying active
  • Bed rest can make problems worse because the back can become stiff and weak
  • Take short walks for 10 to 20 minutes on flat surfaces (avoid hills or stairs when possible)
  • Patients may need to change the way they move when performing activities so they do not cause or worsen symptoms