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I have a herniated disc at L45 that is keeping me off work too long. I need to just get it taken care of and get on with my life. Is it best to have the surgeon take the whole thing out or just the piece that's pressing on my nerves? Does it even matter?
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That's a question many surgeons and researchers have tried to tackle. In fact, over the last 40 years, there have been over 600 studies done on disc-related back pain. Back pain with leg pain is called radiculopathy. A more common name is sciatica. It is caused by pressure on the spinal nerve root or chemical irritation of the nerve root from the herniated disc or disc fragments.
The results suggest that as far as getting back to work as quickly as possible goes -- the more conservative approach of just removing the disc fragments gives the best results. But when patients were followed for two years (or more), the incidence of reherniation was higher in this group compared with a more aggressive (complete removal) approach.
Some other disadvantages of complete disc removal include damage to the nucleus and end plate (between the disc and the next vertebra). The result can be increased back pain and a faster degeneration of the back. In the end, these patients were more likely to need more surgery later.
The surgeon will likely make this decision at the time of the surgery. Based on preoperative MRIs, he or she may have a pretty good idea of how much damage is present, how compromised the spinal nerve is, and the general health of the disc itself. A closer look during the operation will be the final factor used in making the decision.
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