Do Lumbar Disc Herniations Heal Without Surgery?

A recent systematic review and meta-analysis offers some evidence.

The human body is extremely adaptable, and yet modern humans are still plagued by lower back pain.

One of the more painful conditions which can occur is the dreaded herniated disc. Perhaps surprisingly, there are a good number of people walking around with no back pain whatsoever, who have herniated discs and are without symptoms.

In fact, this study showed 8% of asymptomatic young adults (Italian Air Force cadets, so one would assume otherwise healthy individuals) had disc herniations present on their lumbar MRI scans.

So disc herniation by itself may not be the cause of your lower back pain. Advanced imaging may seem like a good idea at first, because we all want to know what and where is exactly the problem. In fact, routine imaging for back pain is not recommended in most cases.

Chances are if you walk into my office complaining of low back pain which travels into the legs or buttocks, weakness, or numbness into one or both legs, you may have a disc problem which will be seen on a scan.

This does not mean you need an MRI of your spine.

Sure, the MRI will likely show a “problem”, but imaging for lower back pain without any red flags present is not advised, for these reasons the Choosing Wisely initiative states:

The tests will not help you feel better faster.

Imaging test(s) have risks.

Imaging tests are expensive.

So when should I have imaging done?

In cases of lower back pain which do not respond well to conservative treatment (physical therapy, over the counter analgesics, spinal manipulation, education, exercise, etc.) or resolve on their own after six weeks, then imaging may be considered. Keep in mind many cases of lower back pain, even cases which may involve disc injury, resolve on their own in 4–6 weeks.

If your treating doctor or other provider notices certain features to your pain such as:

• Weight loss that you cannot explain
• Fever over 102° F
• Loss of control of your bowel or bladder
• Loss of feeling or strength in your legs
• Problems with your reflexes
• A history of cancer

Lumbar spine imaging should be ordered immediately¹.

But it’s six weeks later, my back is still a mess…

Now that you’ve had four to six weeks of recommended care, you are still in a lot of pain and not making the expected progress. A scan is ordered, and if what appears on your imaging lines up clinically with the symptoms you are feeling, we can be much more confident that the images correlate with your back pain and any other symptoms you are experiencing.

Your scan may reveal you have one or more lumbar disc herniations. You may hear or read scary jargon such as “extrusion”, “degenerative” , “disc disease” and more.

Don’t Freak Out

This can be scary, nerve racking, frightening stuff.

Do you need surgery? Injections? Addictive pain medications you’ve seen horrible TV shows about?

In most cases, lumbar disc herniations will resolve on their own with time and non-surgical treatment².

We have good evidence lumbar disc injuries get better without surgery.

Your spinal discs are not squishy doughnuts with jelly squirting out from their middles.

In this study, published in BMC Musculoskeletal Disorders, the authors found that 63% of lumbar herniations treated non-surgically regressed on their own. That is 63% got better without surgery.

The authors do recommend following up at 4 and 10.5 months from onset of pain to evaluate whether surgery would be appropriate.

Final Thoughts

Lumbar discs herniate, but many times they also heal, sometimes regressing spontaneously³.

Don’t rush to get imaging if you have lower back pain without red flags. This is a big one! Improper imaging can lead to worse outcomes, unnecessary surgery, and increased use of addictive opioid pain medications.

Surgery may provide quicker relief from disc herniation symptoms, but medium and long-term outcomes appear to be similar for both conservative and surgical treatment options⁴.

While risk of major complications appears low with surgical treatment such as microdiscectomy⁵, many patients may wish to attempt conservative management before undergoing surgery for a herniated lumbar disc.

Especially knowing that 63% of disc herniations treated non-surgically will resolve within several weeks or months.

References:

1. https://www.choosingwisely.org/patient-resources/imaging-tests-for-back-pain/
2. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03548-z
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256262/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223716/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3745686/