Is Surgery Always Necessary when a Disc Reherniates?

Is Surgery Always Necessary when a Disc Reherniates?

Reherniation does not automatically require surgery. Many patients respond well to conservative treatments such as physical therapy, pain management, and activity modification. However, surgery may become necessary when symptoms are severe, neurological function deteriorates, or nonsurgical approaches fail to provide adequate relief after several weeks. In this article, we explore the factors that determine whether surgical intervention is appropriate for a recurrent disc herniation and what treatment options are available.

What Happens when a Herniated Disc Returns after Initial Treatment?

When a previously herniated disc herniates again, the condition is called reherniation. This occurs when disc material that had either reabsorbed or been surgically removed protrudes once more from the same location. The recurrence can happen at the site of a previous surgery or in a disc that healed naturally but has ruptured again.

Reherniation rates vary depending on the initial treatment approach:

• Approximately 5 to 15 percent of patients who undergo discectomy surgery experience reherniation within the first few years.
• For those who heal without surgery, recurrence rates are less well documented but can occur when the disc experiences repeated stress or degenerative changes progress.

The symptoms of reherniation typically mirror those of the original herniation:

• Radiating pain down the leg or arm
• Numbness and tingling
• Muscle weakness

However, some patients report recurrent episodes feel more intense or respond differently to treatments that worked previously.

How Do Doctors Decide if Surgery Is Necessary for Reherniation?

Physicians evaluate reherniation cases using a combination of clinical examination, imaging studies, and patient history. The decision to operate depends on the severity of symptoms, the presence of neurological deficits, and how well the patient responds to conservative care.

Red flag symptoms that suggest surgery may be necessary include:

• Progressive weakness in the legs or arms
• Loss of bowel or bladder control
• Unrelenting pain that significantly impairs daily function despite medication

These signs indicate nerve compression is severe enough to potentially cause permanent damage if left untreated.

Imaging studies such as MRI scans confirm the diagnosis and determine the size and location of the reherniation. However, doctors do not base surgical decisions on imaging alone. A patient may have visible reherniation on an MRI but minimal symptoms, while another may have significant pain with a smaller reherniation. The clinical picture takes precedence over radiological findings.

Spine specialists often recommend a trial of conservative treatment for several weeks before considering surgery, unless neurological emergency signs are present. This waiting period allows the body time to heal naturally and helps doctors identify patients who will recover without invasive intervention.

What Conservative Treatment Options Work Best for Reherniation?

Conservative management remains the first-line approach for most reherniation cases:

• Physical therapy - Forms the cornerstone of nonsurgical treatment, focusing on core strengthening, flexibility exercises, and posture correction to reduce stress on the affected disc.
• Medication management - Options include:
• Anti-inflammatory drugs for reducing swelling and pain
• Muscle relaxants to address spasms
• Nerve pain medications such as gabapentin or pregabalin
• Oral steroids for short periods during acute flare-ups
• Epidural steroid injections - Offer another option when oral medications prove insufficient. These injections deliver anti-inflammatory medication directly to the area surrounding the affected nerve root, often providing weeks or months of relief. While not a permanent solution, injections can reduce pain enough to allow participation in physical therapy and other rehabilitative activities.
• Activity modification - Plays an equally important role in managing reherniation. Patients learn to avoid movements that aggravate symptoms while gradually returning to normal activities as pain subsides. This process requires patience, as rushing back to high-impact activities can trigger another episode.
• Alternative therapies - Options that provide relief for some patients include:
• Chiropractic care
• Acupuncture
• Massage therapy

Evidence supporting their effectiveness varies, and these approaches work best when integrated into a comprehensive treatment plan rather than used as stand-alone therapies.

When Does Surgical Intervention Become the Recommended Course of Action?

Surgery becomes the preferred option when conservative treatments fail to control symptoms after an appropriate trial period. The following circumstances indicate that surgical intervention should be considered:

• Failure of conservative treatment
• Persistent leg pain that interferes with sleep, work, and basic daily activities
• Symptoms continue despite six to twelve weeks of nonsurgical management
• Pain medications and physical therapy provide insufficient relief
• Progressive neurological deterioration
• Muscle weakness that worsens over days or weeks
• Development of foot drop (inability to lift the front part of the foot)
• Loss of sensation in affected areas that continues to spread
• Declining ability to perform basic motor functions
• Cauda equina syndrome (surgical emergency)

Cauda equina syndrome, though rare, constitutes a surgical emergency. This condition occurs when multiple nerve roots at the base of the spine become severely compressed, causing:

• Loss of bowel or bladder control
• Saddle anesthesia (numbness in the groin area)
• Bilateral leg weakness
• Sexual dysfunction

Patients with these symptoms require immediate surgery to prevent permanent disability.

Quality of life considerations

Some patients choose surgery even when conservative treatment provides partial relief because their quality of life remains significantly impaired. Candidates who may opt for earlier surgical intervention include:

• Professional athletes requiring full physical capability
• Manual laborers whose careers depend on strength and mobility
• Individuals whose daily responsibilities demand pain-free movement
• Patients who cannot tolerate prolonged disability or recovery time

What Surgical Approaches Are Available for Treating Recurrent Disc Herniation?

Revision discectomy represents the most common surgical approach for reherniation. This procedure removes the recurrent herniation through a similar approach as the original surgery, though scar tissue from the first operation can make the procedure more technically challenging.

Common surgical options include:

• Discectomy with fusion - Adds spinal fusion surgery to disc removal, permanently joining two or more vertebrae together. Recommended when the disc has deteriorated significantly or when spinal instability accompanies the reherniation.
• Artificial disc replacement - Removes the damaged disc and replaces it with a mechanical device designed to preserve motion at the affected level. Candidacy depends on factors such as age, overall spinal health, and the specific location of the reherniation.
• Minimally invasive techniques - Address many reherniation cases through smaller incisions with specialized instruments, resulting in less tissue damage, reduced postoperative pain, and faster recovery compared to traditional open surgery.

The choice of surgical technique depends on multiple factors:

• Size and location of the reherniation
• Condition of surrounding spinal structures
• Previous surgical history
• Surgeon’s expertise

A thorough discussion between patient and surgeon ensures alignment between treatment goals and the chosen approach.

What Factors Influence the Success Rate of Reherniation Surgery?

Surgical outcomes for reherniation depend heavily on patient selection and timing of intervention. Studies indicate that patients who undergo surgery for appropriate indications achieve good to excellent results in 70 to 85 percent of cases, though these rates are slightly lower than first-time discectomy procedures.

The interval between the original surgery and reherniation affects outcomes. Reherniations occurring within six months of the initial procedure tend to have better surgical results than those appearing years later, possibly because less degenerative change has occurred in the interim.

Patient factors that influence recovery include:

• Smoking status (smokers face higher complication rates and slower healing)
• Body weight (obesity increases mechanical stress and raises surgical risks)
• Occupation (physical demands affect recovery timelines)
• Psychological health (depression or anxiety may lead to more postoperative pain)

Adherence to postoperative protocols significantly impacts long-term success:

• Following weight restrictions
• Participating in prescribed physical therapy
• Gradually progressing activities as directed
• Avoiding high-risk activities during early recovery

Patients who resume high-risk activities too quickly face elevated chances of experiencing another herniation.

Frequently Asked Questions

Can reherniation be prevented after successful treatment?

Yes, through core-strengthening exercises, proper lifting mechanics, maintaining healthy body weight, and avoiding smoking. While no prevention strategy guarantees immunity, these measures significantly reduce recurrence risk.

How long does recovery take if surgery is required for reherniation?

Most patients return to light activities within several weeks and resume full activity within several months. Recovery timelines vary based on surgical approach, overall health, and adherence to rehabilitation protocols.

Is reherniation more likely to occur after surgery or natural healing?

Reherniation rates are comparable between surgical and nonsurgical treatment when appropriate candidates are selected for each approach. The key factor is addressing underlying biomechanical issues regardless of initial treatment method.

Will I need fusion surgery if my disc herniates again?

Not necessarily. Many reherniation cases are successfully treated with repeat discectomy alone. Fusion becomes necessary only when significant instability or advanced disc degeneration is present alongside the reherniation.

Does having one reherniation mean I will have multiple recurrences?

No. While some patients experience multiple episodes, many who address contributing factors through lifestyle modification, strengthening programs, and proper body mechanics do not experience further problems after appropriate treatment of the second herniation.

Although discectomy surgery is generally a very successful procedure, a hole is left in the outer wall of the disc. Patients with a large hole in the outer ring of the disc are more than twice as likely to reherniate after surgery. A new treatment, Barricaid, which is a bone-anchored device shown to reduce the likelihood of a reherniation, was specifically designed to close the large hole often left in the spinal disc after microdiscectomy. In a large-scale study, 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital.

If you have any questions about the Barricaid treatment or how to get access to Barricaid, ask your doctor or contact us today.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.