“I’ve been suffering from low back pain for a few months now, and an MRI scan shows that I’ve got a bulging disc. I’ve been told that it won’t go back in by itself, so I should try to get surgery. Is this true?”
Let's start with a quick look at some (very simplified) anatomy. The spine is a stack of bones (vertebrae) sitting on top of each other, and a spinal disc lies in between each pair of vertebrae. These discs are sometimes described as being "a bit like jam doughnuts"; they have a fibrous outer layer, with some squishy stuff in the middle. If you squeeze the doughnut, you might start to get some damage to the bit on the outside – it might start to tear or bulge outwards; take it far enough, and eventually the jam might start to leak out.
In another blog, I've already talked about why the jam doughnut analogy might not be the most helpful way to think about the problem. Although it's true that there's no easy way to put the "jam" back in the "doughnut" (anyone who tells you they can just "pop your disc back in again" is either misinformed, or being creative with the truth); unlike a doughnut, your body does have the capacity to recover and to adapt following an injury. Symptoms usually improve over time and the majority of patients with disc injuries do recover by themselves without the need for surgery or other invasive treatment.
Disc degeneration and disc bulges are actually very common. Lots of people, in fact, have some kind of disc damage without having any symptoms of back pain at all, so you shouldn’t be immediately alarmed if an x-ray or an MRI scan result suggests that your discs are showing some signs of wear and tear. It may even be that the findings on the MRI scan are not related to your back pain; research has found that there's no straightforward relationship between damage that shows up on the images and the symptoms of back pain.
It’s also important to remember that surgery comes with some risks attached, and while it often gives relief of nerve symptoms (such as leg pain), it’s generally considered to be less effective when back pain is the main symptom. In fact, when lumbar fusion operations (a common type of lower back surgery) are performed for chronic lower back pain, the outcomes are no better than those achieved by conservative care. In a few cases, it may even make the pain worse. Nowadays, patients are usually advised to try conservative treatment first, before considering surgery.
Does that mean surgery is always a bad idea?
You may have read articles in the popular press suggesting that spinal surgery is “useless”, and sometimes giving the impression that these operations are advocated by surgeons who are deluded at best and fraudsters at worst. Before taking this sort of article at face value, though, it’s important to look more carefully at the evidence on which they’re based. Often the studies being written about may not apply to your particular case, and in some cases the headlines reported by journalists bear only a passing relationship to the conclusions of the researchers' themselves.
It’s always important to get advice about your individual situation before making a decision. There are certainly situations in which surgery is the best answer; for example if you have a severe nerve compression that is affecting muscle function. In other cases, it might be harder to tell what the best treatment might be; if you're unsure, then never be afraid to ask for a second opinion.
A bulging or herniated disc on its own isn’t a sign that you’ll need surgery, and most people with that condition won’t. Whether it’s something that should be considered will depend on the symptoms you’re getting, the exact nature of the injury, how long you’ve had the problem and what else has already been tried.
If you're unsure what the right treatment is for you, then don't hesitate to get in touch with us for a consultation. We take pride in making sure that all our patients are receiving the best possible care; either with ourselves, or by referring patients on to other healthcare practitioners when this is appropriate.