After Physiotherapy How Long Can I Wait Before Surgery for My Lumbar Disc

Q: I just found out my nagging back and leg pain is from a disc herniation. The surgeon tells me I can go to physiotherapy or have the disc removed. I have a trip to Europe planned (the dream of a lifetime). If I go to physiotherapy how long can I wait before having the surgery?

A: Many people do get relief from their painful back and leg symptoms caused by a herniated disc with conservative (nonoperative) care. They may not ever need surgery. Some of the results depend on the severity of the disc problem.

For example, discs can be classified as protruding, extruding, or sequestered. Protrusion describes a situation where the inner disc material has pushed into (but not past) the outer covering. The amount of disc material is equal across the base of the protrusion.

Extrusion refers to the central disc (nucleus) that has pushed through and past the outer covering. The base of the extrusion is narrower than the amount pushing out. Sometimes this is also called a disc prolapse.

If the disc material gets pinched off and separated from the rest of the disc, it's called sequestration. The free-floating fragment can create serious problems if it presses against the spinal cord or spinal nerve roots.

Emergency surgery for disc herniation is rather uncommon. Disc sequestration may be the one exception to that guideline. Most surgeons still recommend that patients try conservative care first for symptomatic lumbar spine disc herniation.

If surgery is going to be done, results will be better if the disc is removed sooner than later and possibly before six months has passed. That is the conclusion of a recent study of over 1200 patients enrolled in a study on disc herniations.

Participants were from 13 multidisciplinary spine practices across the United States. By combining patient information, studies like this make it possible to get more statistically accurate analysis of risk factors and variables (like duration of symptoms) that might affect treatment results.

This study along with others confirm that even late treatment (one to two years after the start of symptoms) offers patients some benefit by way of pain relief and improved function. But the best results are achieved when treatment begins within the first six months of symptom onset.

Reference: Jeffrey A. Rihn, MD, et al. Duration of Symptoms Resulting From Lumbar Disc Herniation: Effect on Treatment Outcomes. In The Journal of Bone and Joint Surgery. October 19, 2011. Vol. 93-A. No. 20. Pp. 1906-1915.