Disc surgery, yes or no? Four questions to ask yourself before you decide

This post doesn't make the surgery decision for you. It gives you questions so you can make it

Key points in 30 seconds

1. In a trial that divided patients with severe leg pain into surgery right away or watching first, results after one year were the same, and the surgery group got relief about twice as fast. Unless it's an emergency, surgery is a matter of choice.
2. First question: are there signs you shouldn't wait on? If you have bladder or bowel problems or reduced sensation where a saddle touches, it's not a matter of choosing.
3. Second question: is your leg strength steadily fading? Pain may go up and down, but if your strength is weaker each week, getting checked comes first.
4. Third question: how much does faster relief matter to you right now? This is where the real choice begins, and neither answer is wrong.
5. Fourth question: if you wait, until when, and how will you check? Set the period and the standards from the start.

What we often hear

• "They say I can have surgery or keep watching it. So what am I supposed to do?"
• "Online, it's half people saying surgery saved them and half saying they regret it."
• "Every night I end up looking at my MRI images again."
• "They say let's wait and see, but no one tells me how long to wait."

"You can have surgery, or you can watch it a little longer."

Hearing this often leaves you feeling more lost. If they'd said "you absolutely need it" or "never do it," there'd be less to agonize over.

This post follows the post on questions to ask about stenosis surgery and the post on questions to ask before a knee injection. This time, the questions aren't for your doctor. They're questions for yourself.

First, the trial behind this dilemma

In the Netherlands, 283 patients who had had severe leg pain from a disc for 6–12 weeks were divided into two paths. One group had surgery right away. The other continued treatment without surgery, and had surgery then if they didn't improve.

After one year, there was no difference in leg pain, everyday difficulty, or how recovered patients felt. The same after two years.

What differed was speed. The group that had surgery right away got out of leg pain about twice as fast. Of those who started without surgery, about 4 in 10 (39%) had surgery partway through, and the rest recovered without it.

So the destination is the same; there's a fast road and a slow road. That means the question to ask is less "is surgery right or wrong?" than "which road is right for me now?" The details and limits of the trial are in the disc surgery post, and how a disc shrinks on the slow road is in the disc reabsorption post.

First question: "Are there signs I shouldn't wait on?"

If the answer here is "yes," you don't need the other questions.

• You have trouble urinating or with bowel movements, or it's become hard to hold them in
• Sensation has dulled in your buttocks, groin or inner thighs

In this case, there's nothing to deliberate: you need a surgical assessment right away. If you come to us, we'll tell you the same thing.

Second question: "Is my leg strength steadily fading?"

Pain and numbness get better and worse while you wait. That's common.

Strength is different. If the strength to lift your ankle or stand on your toes is weaker this week than last week, don't just watch it; get it checked. If things are heading toward weakness, it's right to hurry a surgical consultation.

Third question: "How much does faster relief matter to me right now?"

This is where the real choice begins.

The biggest advantage of surgery shown in the trial was faster relief. So you need to weigh how much that speed is worth in your life.

Can you not take a long time off work? Do you have family to care for? Is the pain keeping you from sleeping, making each day hard to get through? Then choosing the fast road is a perfectly reasonable decision.

On the other hand, if the pain is bearable and life is getting along well enough, the slow road reaches the same place. Neither is a wrong choice.

In the director's case. I've had disc surgery myself. It's something I often share with patients in the clinic. I knew that a ruptured disc usually settles down over time. But back then, my leg was pulling so much I couldn't walk for long, and daily life was so hard that waiting out that time was difficult. So I chose the fast road. That means I have no reason to tell you "surgery is bad," and no reason to tell you "just wait, no matter what." I believe the standard for this decision is how hard your life is right now, more than how far the disc sticks out. Of course, that was my case, and everyone's circumstances are different.

Fourth question: "If I wait, until when, and how will I check?"

If you've chosen the slow road, this is the most important question.

Waiting doesn't mean blindly holding out. In another trial of patients whose leg pain had lasted 4–12 months, the surgery group had less leg pain after 6 months. In other words, just dragging it out does no good.

So we set it from the start: how many weeks until we look again, and what should be better by then to continue, or what staying the same means it's time for a surgical consultation. Four standards are enough.

• Leg pain score
• How far down the numbness goes
• How long you can walk without resting
• Leg strength

We walk the slow road with you

We start by telling you when surgery is the better option. If there are warning signs, if strength is fading, if things don't improve within the set period, or if your circumstances mean you simply must recover quickly, we connect you with the appropriate care.

If you've chosen the slow road, here's what we do.

First, we check. We examine for warning signs and leg strength and sensation, and if needed, look at the disc in partnership with the radiology clinic on the 2nd floor of the same building.

Second, we make it bearable. We ease leg pain with acupuncture and pharmacopuncture (herbal acupuncture), and, within the limits of what the nerve check allows, work on stiff movement with Chuna (Korean manual therapy). So you're not just lying in bed, we also make a plan together to keep up walking and daily activities. In a recent trial that divided patients with long-standing leg pain from a disc into real and sham acupuncture, the real acupuncture group had more reduction in leg pain, and the difference lasted a year. We also tell you its limit: it was done in one country, in chronic patients only.

Third, at the set point, we compare records. We compare the four standards set in the fourth question with where you started, and if things aren't heading in a better direction, we don't repeat the same treatment; we guide you to a surgical consultation.

What changes

Instead of sleepless nights pulling up your MRI images, nights with a plan: "I've chosen this road, and I'll check again on this date."

Whichever road you choose, the confidence that you're standing on a road you chose yourself. That's what we're aiming for.

The right road differs from person to person depending on the state of the disc, symptoms and life circumstances.

Today's takeaway

If there are no emergency signs and no steadily fading strength, disc surgery is a choice to make around your life. If you decide to wait, set the period and the standards at the start.

Today, try writing a one-line answer to each of the four questions, especially the third: "how much does faster relief matter to me?" Bring that note and your MRI report, and whichever road you choose, we'll make a plan for that road together.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.

References

1. Peul WC et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine. 2007;356(22):2245-2256.
2. Peul WC et al. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ. 2008;336(7657):1355-1358.
3. Bailey CS et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. New England Journal of Medicine. 2020;382(12):1093-1102.
4. Tu JF et al. Acupuncture vs sham acupuncture for chronic sciatica from herniated disk: a randomized clinical trial. JAMA Internal Medicine. 2024;184(12):1417-1424.