Surgery is Not the Only Option for Herniated Disc


Surgery is not the only option for your herniated disc

By: Dr. Michael Cutler

Last week we talked about alternative ways to put your back pain behind you. But sometimes low back injury often results in more than just localized pain and requires an imaging study in search of the diagnosis. That’s when your physician may check for criteria for getting an MRI. If that shows a herniated disc or nerve root impingement, he may want to talk about surgery, but there are non-surgical ways you can heal your back and disc disease.

Intervertebral discs

What is an intervertebral disc and why is it so important? While bones don’t fracture easily, the soft disc between each bony vertebra is vulnerable and if damaged can impinge upon the spinal nerves that exit your spinal cord.


Herniated disc

Damaging your disc from a single injury or over time can occur and it happens to young and old alike. When your soft intervertebral disc breaks through its capsule and protrudes (or extrudes) out, it can easily impinge upon your nerve root to cause symptoms of pain, numbness or weakness. So when back pain is more than just localized to the low back area you may need an MRI.

Obtaining a diagnosis

Because plain x-rays of the back will not show soft tissue, a myelogram can be done. This involves an injection of a dye into your spinal canal to view the nerve roots. Also, an electromyogram with nerve conduction studies (EMG/NCS) can be done by your neurologist to actually measure electrical pulses along the suspected nerve pathways to detect where nerve compression or injury actually is.

Magnetic Resonance Imaging (MRI) is the optimal and safest diagnostic test to get a detailed three dimensional picture of your spine and spinal cord damage. It shows alignment, size and shape of vertebral bodies, intervertebral disc space (the disc), paravertebral soft tissues, and particularly the nerve roots that exit from the spinal cord out the neural foramen.

Abnormal results my patients typically have are discs that show “symmetrical bulging” but with no significant spinal stenosis or neural foramen narrowing (nerve roots are fine). Often it will show spondylosis, a general descriptive term which means there is spine and disc degeneration but it does not locate the source of pain.

Significant MRI findings are those with soft tissue disc damage; either disc protrusion (disc material poking out like a finger on a hand) or disc extrusion (disc material completely separated like an oil droplet in water). Most notably, the MRI must correlate with the distribution of your pain/numbness/weakness to be significant. This correlation can be deciphered by simply looking at a dermatome chart which shows the distribution of your nerve roots to the area of your body and limbs that it innervates as shown:


Body image


Body image 2


Disc disease often an incidental finding on MRI

Be aware that just because your MRI shows a disc bulge or protrusion, it may not even be the cause of your pain. Here’s why I say this. In 2008 the famous Cleveland Clinic performed clinical trials, imaging hundreds of subjects using MRI and found that 25 percent of those without symptoms of back or leg pain had a herniated disc! Also as many as 60 percent of seemingly healthy adults (with no back pain) had degenerative spine changes seen on MRI.

An earlier study [1] reported in a 1994 New England Journal of Medicine found that of the 98 subjects without any back pain or leg symptoms who underwent an MRI of the spine, 52 percent of them had at least one bulging disc, 27 percent had a disc protrusion, and 1 percent had a disc extrusion.

Is surgery proven to be the best pathway to healing a herniated disc?

Certainly bowel/bladder incontinence or progressive lower extremity weakness caused by the problem probably require surgery. However, with just lower extremity pain or intermittent numbness you can avoid surgery. Moreover, when we look at scientific studies on this, we find that the healing rates by using surgery are only slightly more effective than just healing on your own. Let me explain the study statistics to support what I am stating.

According to the Maine Lumbar Spine study, at one year [2] 71% of surgically treated and 43% of non-surgically treated patients reported definite improvement. The number of those who were able to get back to work was about the same in each group.

And, for patients with only mild symptoms, surgery versus non-surgery was similar.

Yet when these same patients were followed for ten years the results were even more similar: 69% of patients originally treated surgically reported improvement in their back or leg pain versus 61% of those who were not treated surgically. [3]

Natural healing methods instead of surgery

What can you do instead of surgery to heal symptoms of a herniated disc? Let me give you a partial list here:

  • Pain relievers and muscle relaxant medications while you heal
  • Keep moving actively as soon as possible, but careful to avoid re-injury
  • Correct daily postures: this is the most difficult thing to do because it is so subtle and yet will perpetuate inflammation and pain if ignored
  • Healthy nutrition: consume nutrient rich foods and eliminate refined sugar
  • Nutrient supplements to help rebuild connective tissue such as proline and Lysine (amino acids), B vitamins (B12, B6, B complex), omega-3 oil (3 to 6 grams daily).
  • Physical therapy: massage, ice and heat, traction, ultrasound, mechanical vibration, transcutaneous electrical nerve stimulation (TENS), stretching and strengthening, etc. Some of these can be done on your own at home too, such as cold laser or Homedics dual head vibrator/massager
  • Personal trainer to coach you at a gym to build your surrounding supportive muscle tone

In summary, the main aspects of healing a herniated disc with nerve impingement involve healthy movement and posture, optimal nutrition and nutrient supplements, safe therapies to stimulate healing, and a clear intention to heal.

To healing yourself,

Michael Cutler, M.D.
Easy Health Options

[1] Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73.
[2] Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, Singer DE. The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica. Spine (Phila Pa 1976). 1996 Aug 1;21(15):1777-86.Spine Study, Part II.
[3] Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005 Apr 15;30(8):927-35.

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