When Do You Need Surgery for a Herniated Disc? (Fix Root Causes)

What you can do about a slipped disc instead of surgery

By Coach E

When do you need surgery for a herniated disc? Perhaps less often than you think. We’ll dive into why, when surgery is appropriate, and how to address the root cause. 

So you just got your MRI results and found out that you have degenerative disc disease or disc herniation.

First of all, stop doing these four common exercises. It’ll just make your disc herniation symptoms worse.

Anatomy of a Slipped Disc

Next, you need to know what a disc is. An intervertebral disc is a shock absorber that sits between two of the vertebral bodies in your spine.

There’s a tough outer fibrous layer known as the annulus, which, over our lifetime, can break down. Repetitive bending or flexing action leads to increased stress on the disc, which eventually leads to increased stress on the disc. That, in time, causes tearing.

disc herniation anatomy - when do you need surgery

When the annulus tears, the soft inner portion of the disc can start to protrude into the tear. Eventually, when there’s a complete tear (a hole in the annulus), the disc material will actually protrude (aka herniate) through the annulus. The herniation can apply pressure to the nerve root.

There’s a continuum to disc herniation, sometimes also called a slipped disc.

  1. Degeneration
  2. Bulging
  3. Protrusion (prolapse)
  4. Extrusion / Herniation
  5. Sequestration (disc material free within the spinal canal)

Degeneration happens to all of us as we age.

stages of disc herniation degeneration

How Common is Disc Degeneration?

Dr. B found a great research study called “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomactic Populations.”

The “asymptomatic populations” means people without back pain. In plain English, the study reviewed spinal degeneration in people without back pain. [1]

Dr. B says:

“It’s very interesting to me that disc degeneration increases with each decade of life.

For example, 68% of 40-year-olds have disc degeneration compared to 88% of 60-year-olds. So almost everybody by the age of 60 has some evidence of disc degeneration. But remember, they don’t necessarily have symptoms.

Then, if we look at the continuum of disc herniation, we see that 50% of 40-year-olds have a disc bulge compared to 69% of 60-year-olds who have a disc bulge.

Then 33% of 40-year-olds have disc protrusion compared to 38% of 60-year-olds who have disc protrusion.

This is a significant number of people who have degenerative disc disease on an MRI, and yet these people do not have any symptoms whatsoever.”

It’s not the MRI that determines whether or not you have pain.

If you have back pain, get an MRI, and the MRI finds evidence of disc degeneration, what do you do?

Well, go to your doctor! Your doctor should examine you and correlate your symptoms and your physical examination findings to what they found on the MRI.

It’s not uncommon to have a disc herniation that’s affecting the right side of your body, and meanwhile, your pain is in your left leg. There’s no correlation there between the MRI and your symptoms.

The doctor should examine you, looking for changes in sensation in your legs and hip area. They will check your reflexes, and they’ll check your muscle strength. Changes in sensation, loss of reflexes and decreased muscle strength in a specific pattern correlates with one of the lumbar nerve roots.

When Do You Need Surgery for a Herniated Disc?

So the big question. Do you need surgery or not?

Most disc herniations reabsorb over six to twelve weeks and don’t require surgery.

There are two situations that may require surgery.

One is an absolute emergency. It’s called cauda equina syndrome. That is when a large central disc herniates and applies pressure to the nerve roots that supply your bladder and your legs.

In this case, you would experience the following:

  • pain/weakness in your legs
  • loss of sensation around the perineum
  • urinary or bowel incontinence

If you have any of these symptoms, go straight to the emergency room. Literally, stop right now and go. It’s that serious. You need an emergency operation.

The other time surgery may be required is if your pain and strength have not improved after 12 weeks. This is something you would have to go and speak to your surgeon about to see if you’re a candidate.

The vast majority of people will respond to a disc herniation without surgery.

But here’s the key.

The most important thing to understand: why did your disc herniate in the first place?

poor posture back pain

Disc Herniation Causes

Whether you have surgery or not, we need to get to the root cause of your degenerative disc disease.

The common causes we see are:

  • Poor deep core muscle activation
  • Stiff hips
  • Poor posture

Dr. B says:

“A point I’d like to make in my own experience with back pain – I would go do my exercises, and I’d feel great. But then I’d sit and slump at my desk for 12 hours a day.

Make sure that you do your exercises, but then you also pay attention to your posture and your overall lumbar alignment throughout your day.”

First, if you have stiff hips (and this often occurs in people who sit throughout the day), start off improving the mobility of your hip flexor muscles. This article on “How to Fix Tight Hip Flexors” will give you a great start.

What about poor posture? Forward head posture can put a ton of pressure on your spine. Start correct forward head posture (aka hunchback or caveman posture) with the article and exercises here.

Okay, so what do you do if your pain is a six or less out of ten? Click over to our questionnaire to see what type of low back pain you have, and get two free routines that will get you started on recovery and address the root causes within a couple of days.

If your pain is seven or more out of ten, go to our Spine Control Program and check out the acute back pain routine. It’ll build resilience, functional integration, and dynamic strength to keep you doing what you love.

Just because you have some degenerative changes on your MRI doesn’t mean that you’re doomed for surgery or a wheelchair. Address the root causes, and you can stay active and pain-free.

Thanks for sticking to the end of the article!

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.