Slipped disc: when do you need back surgery?

What a slipped disc is

The discs between the bones of the spine have a soft centre. When part of it bulges or breaks out, it can press on a nerve. In the lower back this usually causes pain that shoots down the buttock and leg, often below the knee, with tingling or numbness: this is sciatica. The leg pain is often worse than the back pain.

Emergency signs: go today

These can mean the nerves at the bottom of the spine are being squashed (cauda equina syndrome). Go to an emergency department immediately, do not wait for an appointment, if you have back or leg pain with any of these:

• Numbness or tingling around the bottom, genitals or inner thighs (the area you would sit on a saddle)
• Difficulty passing urine, not knowing when your bladder is full, or leaking urine
• Loss of control of your bowels
• Weakness or numbness in both legs, or a foot that is getting weaker
• Back pain with fever, weight loss, a history of cancer, or after a fall or accident

What usually helps first

Bed rest for days is no longer advised: keep moving as much as pain allows, and slowly do more each day. Painkillers help you stay active; your doctor may suggest medicines for nerve pain. A physiotherapist can guide exercises and reassure you about what is safe. Avoid forceful manipulation or heavy massage of an acutely painful back and leg. Most people improve steadily over weeks.

When surgery is considered

UK guidance says spinal decompression can be considered for people with sciatica when non-surgical treatment has not worked and the imaging fits the symptoms. In practice surgeons discuss surgery when:

• Severe leg pain has not improved after a reasonable period of good non-surgical treatment
• There is weakness in the leg or foot that is getting worse
• The pain is so severe it cannot be controlled even with strong medicine
• An MRI shows a disc or narrowing that clearly matches where the pain goes

What the operation does, and what it does not

Decompression surgery (such as a discectomy) removes the part of the disc or bone pressing on the nerve. It is mainly for leg pain: many people feel the leg pain ease soon after. It is less reliable for back pain alone, and it does not stop discs wearing elsewhere in the spine. Like any spinal operation it carries risks, including nerve injury, a leak of spinal fluid, infection and the disc slipping again. Your surgeon will go through these for your case.

An MRI report saying "disc bulge" is very common, even in people without pain. A scan finding alone is not a reason for surgery: it has to match your symptoms and examination.

Getting an honest opinion

Bring your MRI images and report, a list of treatments you have tried and for how long, and a clear description of where the pain goes. On Mezo, spinal decompression is quoted after the surgeon's consultation, because what is needed varies widely; you get a written all-in quote before agreeing to anything, and you pay online.

Common questions