I have had a herniated intervertebral disc in my low back and sciatica for three months now. Do I have to be operated?

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 19 June, 2011

Should the patient observe gradual and continuously increasing loss of muscle strength or/and urinary/defecation incontinence or newly manifested urinary/defecation disorder, only then must s/he urgently resort to surgery.

About 90% of cases of sciatica due to herniated intervertebral disc are successfully treated with conservative or interventional pain therapy. Only some 10% of the cases should resort to surgical treatment because this is dictated by the deteriorating neurological picture.
Herniation is like a cold, it is self-cured. Should pain persist for more than 4-6 weeks despite the conservative treatment (short-term rest, anti-inflammatory drugs and physiotherapy), then interventional pain techniques are applied with high success rates, e.g. transforaminal epidural corticosteroid injection and neuroplasty with RACZ catheter.

These techniques are to treat nerve inflammation and adhesions induced, and in this way sciatica pain subsides.
So, pain emanates from nerve inflammation (radiculitis) and only in 10% of cases it is due to intense nerve compression by the herniation. This 10% of patients manifest not only pain but also the symptoms mentioned above.

The herniation shown in the MRI regresses on its own after some months. Besides, about 40% of people may show a herniated intervertebral disc in the MRI although they do not have any symptom at all.
In any case, you should always discuss with your physician in order to take together the proper decisions.