The following 3 situations may lead to surgery:
1. Persistent disabling leg pain with failure of non-operative treatment over approximately 6 weeks.
2. Progressive weakness in the leg.
3. Cauda equina syndrome, which is characterized by intense back and leg pain, weakness in the legs, numbness in the groin and buttock area, and difficulties with bowel and bladder function.
The most common surgery to address a lumbar disc herniation is a microdiscectomy. This surgery consists of removing a small amount of bone and ligament from the back of the spine in order to access the disc. The nerves are protected, the disc herniation is identified and then removed. The majority of the disc is left intact and still provides stability to the spine. In most cases the surgeon uses magnifying eyeglasses or a microscope in order to perform this surgery through a small incision.
Some surgeons send patients home the same day after this surgery, while in other cases patients stay overnight. The wound is quite tender for the first few days after surgery, and most surgeons send patients home with prescription narcotic medications. You can typically get out of bed and walk within an hour or two after surgery is completed. Many patients who have sedentary office jobs can return to work within 2-4 weeks, while those who have jobs requiring heavy lifting will often need to be out of work for 6 weeks.
Most patients experience at least 80% improvement in leg pain and 70% improvement in low back pain. Leg weakness and numbness and tingling are less predictable, and patients can expect approximately a 50% improvement.