Surgery or conservative management for disk herniation, which is better? Disk herniation series part 3.

My answer contains a bias.  All clinicians see other clinicians failures and, inversely, we do not see their successes since patients who are cured have no need to seek another provider’s care.  As such I have seen many patients who have received insufficient help from spinal surgeries, as well as a significant number of patients who were made worse by them.  Some studies have concluded that patients are more likely to recover from symptomatic lumbar (lower back) disc herniations if they seek no form of care whatsoever than if they undergo back surgery.  Surgery is risky, expensive, and requires significant recuperation time, including lost time from work and often lengthy and painful rehabilitation.  From my perspective, for these reasons surgery should be considered only for patients for whom the diagnosis suggests a favorable response, and even then, only as a last resort option.

Neck and back pain, in my experience, rarely are helped by spinal surgery, whereas radiculopathies (pinched nerves) are almost always helped (to some degree) by the right kind of surgical intervention.  Conservative treatment such as traction, chiropractic manipulation, core strengthening, nerve stretching, and special exercises designed to decompress the pinched nerve(s) is usually successful, especially when combined with anti-inflammatory medicine, such as prednisone.  The course of care should be relatively short (typically 4-8 weeks) to return patients to being fully functional and pain-free.  If after a 1-2 month course of care a patient is not significantly improved (at least 75% better), the prognosis for conservative management becomes poor and, depending on the particular needs, symptoms, and health of the patient, it is at this point that I recommend the surgical option be considered.