Am I A Candidate for Lumbar Herniated Disc Surgery?

If you’re struggling with severe or persistently bothersome leg pain resulting  from a herniated disc, you’re likely searching for the best solution to help you find relief. Pain caused by herniated discs in the lumbar spine can be debilitating, disabling, and take away from  your overall quality of life.

There are both surgical and nonsurgical treatment options available to relieve pain from a herniated disc. While many people have excellent results after pursuing herniated disc surgery, also known as lumbar discectomy, not everyone is considered a good candidate. There are certain risk factors that can interfere with the surgical outcome and recovery. 

In this article, we review the common signs of a herniated disc, as well as what makes a patient a good or poor candidate for surgery to relieve painful symptoms.

Common Signs of a Herniated Disc in the Lower Spine

The most common symptoms of a herniated disc include:

• Shooting pain (sciatica)
• Numbness or tingling in the legs
• Weakness or loss of muscle control
• Inability to lift the foot (foot drop)
• Decreased mobility
• Lower back pain

Although none of these symptoms are a certain indication of a herniated disc, they may be signs of one. While herniated discs are relatively common, most patients never need herniated disc surgery; perhaps surprisingly, it is even possible to have a herniated disc and experience no symptoms at all. 

Often, herniated disc symptoms can be addressed with medication and other conservative treatment options. Weight loss, formal physical therapy, home exercise programs, smoking cessation, chiropractic treatment, and injections can also help treat the symptoms of a disc herniation before surgery is necessary.

If you think you may have a herniated disc, the first step is to see a doctor for further testing and a confirmation of a diagnosis. Your physician may recommend a magnetic resonance imaging (MRI) scan and selective diagnostic injections to identify the problem area and to confirm the root cause of the pain you’re experiencing. 

If it’s determined that you do indeed have a herniated lumbar disc, the next step is to proceed with the least invasive treatment pathway. If nonsurgical treatment options prove to be unsuccessful, you can then move on to explore more invasive procedures such as lumbar discectomy.

Candidate Qualifications for Herniated Lumbar Disc Surgery

You may be considered a good candidate for herniated disc surgery if:

You live an active lifestyle

Active patients are much more likely to experience lasting pain relief and improved mobility after herniated disc surgery. Additionally, if you typically live a very active lifestyle but find that painful symptoms are interfering with your daily activities, surgery may be a good next step to get you back on your feet (and back to play) as soon as possible. 

You’ve tried nonsurgical treatments without success

Conservative treatments like medications, exercises, and massage can prove very effective in relieving leg pain caused by a herniated disc. However, if you’ve already tried nonsurgical treatment options with no luck, you may be a good candidate for surgical intervention. 

You have severe leg pain (sciatica)

More than any other symptom, herniated disc patients experience sciatica, or shooting pain that radiates down the leg and into the foot, hips, and buttocks. In fact, disc herniation is the most common cause of sciatica¹, which can be caused by a variety of spinal conditions. Those with sciatica as a primary symptom are often considered optimal candidates for discectomy surgery, regardless of the level of back pain you have.

You’re unable to control your bladder/bowel function

In the most severe cases, a herniated disc can compress nerves in the spine that control bowel and bladder functions, ultimately causing urinary incontinence and loss of bowel control. If you begin losing control of your bladder and/or bowels, herniated disc surgery may be medically necessary.

Potentially Disqualifying Factors for Surgery

On the other hand, you may not be an ideal candidate for herniated disc surgery if:

You have mostly back pain

If your primary symptom is back pain, and you don’t have many of the leg or radiating symptoms described above, you may not be a candidate for herniated disc surgery. When you primarily experience back pain, your symptoms may be due to something other than, or in addition to, a herniated lumbar disc.

You’re substantially overweight

Being overweight puts added stress on your lumbar discs and can lead to issues with surgery and recovery. Obesity increases² operative times, blood loss, treatment costs, mortality risks, infection rates³, and length of hospital stay in comparison to patients at a lower weight. Additionally, being obese can increase the risk of reherniation⁴ after herniated disc surgery. 

You’re a smoker

Smoking interferes⁵ with the body’s natural ability to heal itself, impacting the circulation of blood in small vessels, preventing proper nutrients from reaching discs, and impeding recovery. Smoking cessation reduces the risk⁶ of complications and poor outcomes after herniated disc surgery.

You have a severe illness

If you have a severe illness that puts you at greater risk of reherniation or surgical complications, surgery may not be the best option for you. Your spine surgeon may recommend nonsurgical treatment options instead of surgery based on your family history and overall health.

Reducing Reherniation with an Annular Closure Device

In the past, patients with large annular defects (6mm or greater) were considered less-than-ideal discectomy candidates due to increased risk of reherniation. However, thanks to advancements in surgical techniques and technology, this is no longer the case. Although patients with large holes present in the disc are 2.5 times⁷ more likely to experience symptomatic reherniation, this can potentially be prevented with implantation of an annular closure device (ACD) like Barricaid. 

Barricaid technology has demonstrated significant benefits, enabling surgeons to perform more disc-preserving discectomies while reducing the risk of reherniation, associated reoperations, and early readmissions. In a study of lumbar discectomy patients with large defects, use of the Barricaid implant resulted in a 60 percent reduction⁸ in reoperations for reherniation.

What’s Next?

While there are certain qualities that indicate whether someone is a good (or not-so-good) candidate for herniated disc surgery, only a spine surgeon can make the final determination about the best treatment approach for you. Consult with a specialist in spinal conditions to make a plan that best suits your unique situation.

While this blog is meant to provide you with information you need to make an informed decision about your treatment options, it is not intended to replace professional medical care or provide medical advice. If you have any questions about the Barricaid, please call or see your doctor, who is the only one qualified to diagnose and treat your spinal condition. As with any surgical procedure, you should select a doctor who is experienced in performing the specific surgery that you are considering.

If you have any questions about Barricaid, you may ask your doctor. For additional information, please visit www.barricaid.com. For complete risk-benefit information: www.barricaid.com/instructions-for-use. 

References:

1  Roger Härtl, “Lumbar Herniated Disc Symptoms,” Spine Health, Vertias Health, 2016, https://www.spine-health.com/conditions/herniated-disc/lumbar-herniated-disc-symptoms.
2 Keith L. Jackson and John G. Devine, “The Effects of Obesity on Spine Surgery: A Systematic Review of the Literature,” Global Spine Journal 6, no. 4 (2016): 394-400, doi:10.1055/s-0035-1570750.
3  Olivia J. Bono et al, “Body Mass Index Predicts Risk of Complications in Lumbar Spine Surgery Based on Surgical Invasiveness,” The Spine Journal 18, no. 7 (2018): 1204-1210, doi:10.1016/j.spinee.2017.11.015.
4 George Fotakopoulos et al, “Recurrence Is Associated With Body Mass Index in Patients Undergoing a Single-Level Lumbar Disc Herniation Surgery,” Journal of Clinical Medicine Research (2018): 486-492, doi: 10.14740/jocmr3121w.
5 Susan Spinasanta et al,  "Smoking, Tobacco Use, E-Cigarettes And Spine Surgery," Spine Universe, Remedy Health Media, updated July 16, 2019, https://www.spineuniverse.com/treatments/surgery/smoking-tobacco-use-cigarettes-spine-surgery.
6 Keith L. Jackson and John G. Devine, "The Effects Of Smoking And Smoking Cessation On Spine Surgery: A Systematic Review Of The Literature," Global Spine Journal 6, no.7, (2016)): 695-701, doi:10.1055/s-0036-1571285.
7 Larry Miller et al, “Association of Annular Defect Width After Lumbar Discectomy with Risk of Symptom Recurrence and Reoperation,” Spine (Phila Pa 1976). 2018 Mar 1;43(5):E308-E315. doi: 10.1097/BRS.0000000000002501.
8 Claudius Thomé et al, “Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial,” The Spine Journal 18, no. 12 (2018): 2278-2287, doi: 10.1016/j.spinee.2018.05.003.