Herniated discs: when is surgery necessary?

Wai Weng Yoon, Jonathan Koch, Wai Weng Yoon, Jonathan Koch

Abstract

In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level.In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications.In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure.In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care. Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020.

Keywords: disc herniation; evidence; surgical indications.

Conflict of interest statement

ICMJE Conflict of interest statement: The authors declare no conflict of interest relevant to this work.

© 2021 The author(s).

Figures

Fig. 1
Fig. 1
A 38-year-old semi-professional cyclist with nine-month history of progressive arm weakness and unsteady gait. (a, b) Magnetic resonance imaging (MRI) demonstrated a herniated disc at C5/6 and C6/7 levels. (c) The patient had a C5/6 and C6/7 anterior cervical discectomy and fusion. (d) Postoperative MRI at 12 months.
Fig. 2
Fig. 2
A 74-year-old female patient presented with five days worsening back pain and left leg numbness. Feels pins and needles over perianal area and perineal area with one episode of urinary retention. (a–d) Magnetic resonance imaging demonstrated a giant herniated disc at T9/10 level and a computerized tomography scan confirmed the characteristic calcification. (e) The patient had T9/T10 corpectomy and discectomy with anterior reconstruction (cage + lateral plate fixation).
Fig. 3
Fig. 3
A 28-year-old female patient presented with acute onset back pain and bilateral leg numbness. Altered sensation over perianal area and perineal area with urinary retention. (a, b) Magnetic resonance imaging (MRI) demonstrated a herniated disc at L4/5 level. (c, d) the patient had L4/5 discectomy, and this is the postoperative MRI at 12 months.

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