A herniated disc
A herniated disc – sometimes known as a slipped or a ruptured disc – refers to a problem with one or more of the soft cushions (discs) between the bones (vertebrae) that make up your spine. A disc is a little like a jelly donut, with a soft, gel-like center (nucleus) inside of a tough outer part (annulus).
A herniated disc occurs when some of the softer disc material pushes out (herniates) through a weakness or hole in the tough outer part. If the disc herniation is large enough, the disc material can press on the nearby spinal cord or nerves. This can result in shooting pain (sciatica), numbness or weakness in one or both legs and sometimes back pain.
If you have leg pain caused by herniated lumbar discs, non-surgical alternatives include medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), pain-killers, oral and injectable steroids. Your doctor may also prescribe rest, exercise, and physical therapy. If your pain will not go away or gets worse, or if you start having nerve problems such as numbness, your doctor may prescribe surgery. Surgical alternatives vary, depending on your disc herniation, how much back pain you have, and other factors. The most common surgery is discectomy when your surgeon reaches the damaged disc from the back of the spine—through the muscles and bone.
Less frequently your doctor may recommend a fusion or artificial disc replacement.
Am I at higher risk for a repeat herniation?
Despite discectomy surgery generally being a highly successful procedure, certain patients are at a higher risk of recurrent herniation following surgery. Many of the risk factors for recurrent herniation are patient-related, such as age, smoking, gender, and diabetes. However, a large hole in the outer ring of your disc (annulus) more than doubles the risk of symptom recurrence and reoperation.
If the hole in your disc is larger than a standard pencil-top eraser (approximately 6mm) you stand a one-in-four chance of experiencing a reherniation – and a return to debilitating pain. Most reherniation episodes occur within two years of surgery.
Based on currently available clinical research,1 you stand a one-in-three chance of having such a hole in your disc.
The burden of repeat surgery
It is generally understood that outcomes following repeat surgery are not as good compared to a first surgery and should therefore be avoided if possible. Reoperation for recurrent herniation is often associated with worse clinical outcomes, patient morbidity, and work loss.
- LE Miller et al. Association of Annular Defect Width After Lumbar Discectomy With Risk of Symptom Recurrence and Reoperation. Spine 2018