[Medical Q&A] What kind of lumbar disc herniation requires surgical treatment?

Planner: Chinese Medical Association

Reviewer: Han Liqiang, deputy chief physician, Tianjin University Central Hospital

"Lumbar disc herniation" is definitely not unfamiliar to people who often suffer from low back pain. It is a common and frequently occurring disease. Most patients can be relieved or cured through regular conservative treatment. Only a few patients with lumbar disc herniation require surgical treatment.

There are four main situations that require surgical treatment. The first situation: recurrent lumbar disc herniation, that is, after receiving regular conservative treatment (at least 3 months), the condition is sometimes better and sometimes worse, the symptoms recur or gradually worsen, and pain or numbness begins to appear in the legs. The second situation: disc herniation combined with lumbar spinal stenosis, some patients have to stop and rest for a while after walking 100 to 200 meters before they can continue walking. This phenomenon is intermittent claudication. At this time, only surgery can be performed to expand the volume of the narrow spinal canal and completely relieve the pressure to relieve or eliminate the symptoms. The third situation: severe disc herniation or prolapse, resulting in severe pain in the lower limbs, making it difficult for patients to move and fall asleep, and they must keep their bodies in a certain posture to relieve the symptoms. Some patients can only kneel, and conservative treatment is generally ineffective. It is recommended that such patients undergo surgery as soon as possible. The fourth situation: sudden huge protrusion or prolapse of the lower lumbar disc, which will compress the cauda equina nerve, leading to lower limb weakness and bowel and urination disorders. It is clinically called "cauda equina syndrome" and requires emergency surgery. Of course, the timing of surgery and the type of surgery to be used require specific analysis based on the patient's specific condition and imaging examinations.