Herniated Disc Surgery

Herniated disc surgery is still a popular treatment modality, despite a long history of failed procedures and often dismal curative results. Surgeons have invented a seemingly endless procession of invasive treatment options for herniated disc issues, yet the statistics for postoperative resolution of painful symptoms contraindicate surgical interventions in the vast majority of cases. Unfortunately for most patients who do undergo surgery, they learn this lesson too late, as the damage to their spinal tissues may be permanent and physically debilitating.

Herniated disc surgery comes in many forms and each tries to solve disc concerns in different ways. In the past, most herniated disc operations were fully open, involving massive incisions, 5 to 10 inches long, and complete dissection of the back musculature. Now, minimally invasive procedures and laser based techniques have virtually eliminated fully open back surgery in most cases. This is about the only good thing I have to say about surgery for back pain...

Even with advanced arthroscopic and fiber optic guided surgical techniques, the fact of the matter remains that surgery is almost never needed for herniated discs and the procedures often make matters worse, either immediately or eventually. There is little, if any, evidence that herniated discs are painful and lots of evidence to the contrary. Even in cases where discs may be the source of pain, tingling, numbness or weakness, there is no evidence that surgery is the best course of action, and once again, loads of evidence to the contrary...

The most common type of herniated disc surgery is the discectomy. The various manifestations of this operation are all geared towards removing part of the bulging or ruptured disc, in an effort to resolve pain and related neurological symptoms. This procedure can be useful in a very small number of patients who actually are suffering from ongoing nerve compression issues, but the majority of operated patients do not need this, or any, surgical assistance. In fact, the nature of discectomy leaves the intervertebral disc structure prone to further advanced degenerative effects and the possibility for a more severe herniation increases drastically. I have seen many patients who did not need surgery originally, but surely needed some desperate help after the operation, since the disc structure had been so compromised by the removal of tissue that the surrounding spinal levels actually become unstable. It is a sad situation to be sure.

Occasionally, some traditional surgeons add a laminectomy or hemilaminectomy to the discectomy operation. Laminectomy, in all forms, is best when used for extreme arthritic osteophyte treatment, not for disc issues and is one of the main reasons for postoperative pain in discectomy patients.

Less invasive and slightly more enlightened surgical options include IDET and nucleoplasty techniques. These far less damaging procedures involve shrinking intact bulging discs blamed for enacting painful symptoms using heat or radio waves introduced via tiny catheter directly into the disc. Although results are not bad, it does not change the fact that most patients do not need the procedures, since the treated disc is rarely the source of the actual pain experienced. When compared to placebo, or even the simple passage of time, these techniques demonstrate only a slight edge for postsurgical statistics.

Disc replacement surgery is used for herniated discs and advanced degenerative disc disease. Of all surgical options, this one is the most in tune with the natural design of the spine. The goal is to maintain flexibility and function, while replacing a supposedly badly damaged intervertebral disc. Even though I like the concept in artificial disc replacement, it does not make the operation necessary in most treated patients. Most would probably enjoy better results being treated nonsurgically and long term statistics about synthetic discs remain a potential catastrophe if the devices fail over the course of an extended time frame.

This brings us to my greatest nemesis in the herniated disc surgery sector... spinal fusion. This brutal and insane operation seeks to solve disc issues by literally welding the spinal levels together using bone grafts secured by hardware including screws, plates, rods and cages surgically implanted in and around the backbone. Fusion has a few special uses in the medical industry, but should not be used for treating back pain due to herniated discs. Fusion is never a solution. At best, it is a temporary fix, since the procedure hastens spinal degeneration in the surrounding vertebral and intervertebral levels exponentially. Basically, fusion begets more fusion in almost every case. Once a fusion is complete, it is simply a matter of time before the patient requires follow up operations which will slowly deplete them of all normal function and most often leave them with intractable pain which can make life a living hell. The point to remember is that fusion is contrary to the natural form and function of the spine and is therefore a huge liability akin to a ticking bomb implanted in the back...