The numbers in this section are for discectomy (standard discectomy and microdiscectomy), the most common surgery for herniated disc.
Recovery rates with back treatments*
||With nonsurgical treatment
|Symptom-free or almost symptom-free within 3 months
||50 to 60 out of 100
||20 to 30 out of 100
|Symptom-free or almost symptom-free within 1 year
||90 to 95 out of 100
||80 to 95 out of 100
|Need for surgery within 4 years
||10 out of 100
||10 out of 100
Examples of serious risks with back surgery*
||With standard discectomy
|Permanent nerve damage
||10 to 20 out of 1,000
||1 to 3 out of 1,000
||1 to 2 out of 1,000
||1 out of 1,000
*Based on the best available evidence (evidence quality: borderline to inconclusive)
There is no high-quality evidence showing that surgery is more helpful than nonsurgical treatment for a lumbar herniated disc. The quality of the evidence is borderline to inconclusive.
Take a group of 100 people who have sciatica caused by a herniated disc
. The chances of having no symptoms or almost no symptoms 3 months later may be a little higher with surgery than with nonsurgical treatment:
- With surgery, 50 to 60 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 40 to 50 may still have symptoms.
- With nonsurgical treatment, 20 to 30 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 70 to 80 may still have symptoms.
After a year, the gap in recovery between those who used surgery and those who used nonsurgical treatment is much smaller.
- At 1 year after surgery, 90 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 10 may still have symptoms.
- After 1 year of nonsurgical treatment, 80 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 20 may still have some symptoms.
When it comes to the need for surgery within the next 4 years, there is no difference.
- If they all have back surgery, 10 out of 100 people may need surgery again within 4 years.
- If they all use nonsurgical treatment, 10 out of 100 people may need surgery within 4 years.
The evidence suggests that, like most surgeries, back surgery may have some risks. The risks may be higher for standard discectomy than for microdiscectomy, which uses a smaller incision and causes less tissue damage. The quality of the evidence about risks is borderline to inconclusive.
Take a group of 1,000 people who have back surgery
. The more serious risks include:
Permanent nerve damage. With standard discectomy, 10 to 20 people out 1,000 may have lasting nerve damage, which means that 980 to 990 out of 1,000 may not. With microdiscectomy, the risk of nerve damage is lower: 1 to 3 people out of 1,000.
Death. With standard discectomy, 1 to 2 people out of 1,000 may die because of the surgery, which means that 998 to 999 may not die. With microdiscectomy, 1 person out of 1,000 may die because of the surgery.
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.3, 4, 5, 6, 7, 8, 9, 10 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.