Lumbar disc herniations are painful. They put pressure on the nerves and cause severe pain down the leg and may render a person unable to walk due to the pain or sometimes weakness in the leg, This is a traumatic episode in a patient’s life. Not only from the pain and dysfunction that the disc causes, but trying to make the best decision for treatment. Most disc herniations will improve with non-surgical treatments; steroid pills or shots, physical therapy and time.
Lumbar Spine Surgery
However, in those patients who have more severe pain or weakness that is not controlled with medications and limits their ability to do exercises or rest, surgery is the best option. Surgery works very well in 93% of patients for decreasing the pain quickly around the nerve compression, but this can be a tough decision for the patient and family. As studied in the Journal Neurosurgery (May 2023) the same disc that had surgery may re-herniate in 7% of these patients. This is cause for concern as patients feel let down by the first surgery. The same treatment options are available for a recurrent disc herniation as for a primary disc herniation, including pills, steroid shots, physical therapy or surgery. Almost all patients after disc herniation surgery will have had very good relief of their nerve pain, even in recurrent disc herniation surgery. Because patients felt the effects of relieving the nerve pain, I find these 7% of patients most often want to proceed with another surgery but they want it to last longer.
Discectomy vs. Discectomy with Spinal Fusion
There has been some debate in spine surgery about the right surgical option, from performing another discectomy to remove the piece of disc that has re-ruptured vs. taking the rest of the disc out and fusing the bones together. A recent study from China (PLOS, March 4, 2025) reviewed 20 studies with 7 different surgical treatments for recurrent disc herniation. This included 1556 patients who had previous disc herniation surgery. Of the 7 different surgical approaches including different techniques for removing a disc fragment or removing the whole disc and fusing the bones, they found that both groups got similar pain relief from surgery. But the fusion group had a 0% recurrence of a third disc herniation and was a better choice for the long term.
Discectomy with Spinal Fusion for Re-Herniation
This makes sense as an outcome, in that if the surgeon takes out the whole disc, the disc cannot reherniate. The addition of the fusion to the level also helps to alleviate any back pain that would be associated with removing more disc at the second surgery. The removal of disc will decrease the cushion between the vertebral bones each time that it is done and eventually lead to back pain as the bones will begin to rub against each other. There is no right amount of disc that is needed between the bones, which makes it difficult for surgeons to know if they are taking too much of the disc out. The risk of removing too much disc material and causing back pain is then requiring another surgery to fuse the bones together. For the best outcome and to avoid more surgery, a complete discectomy and fusion is the recommendation.
Request a Consult with a Spine Surgeon in Newport News, VA
If you are suffering with back pain, the spine surgeons at Orthopaedic & Spine Center can help. To schedule a consultation with Dr. Jeffrey Carlson, or any of our spine surgeons in Newport News, please call 757-596-1900 or request an appointment online.