Seeing the words “herniated disc” on an MRI report can be concerning, especially when you are already dealing with back pain, leg pain, numbness, tingling, or weakness. 

But a herniated disc on an MRI does not automatically mean you need spine surgery. 
The first step is determining whether the MRI finding actually explains your symptoms.

An MRI is an important diagnostic tool, but it is only one part of the picture. Determining the right treatment starts with understanding your symptoms, physical examination, and imaging together. For some people, a lumbar disc herniation can improve with time and nonsurgical treatment. For others, surgery may provide significant relief and may sometimes be necessary. The important finding isn't just what the MRI shows; it’s what the MRI finding means for the patient.

What is a Lumbar Disc Herniation?

The lumbar spine is made up of five vertebrae in the lower back. Between these bones are spinal discs that provide cushioning and help the spine move. Each disc has a softer inner portion surrounded by a tougher outer layer. A disc herniation occurs when disc material pushes through or beyond its normal boundary.

Depending on its location, a herniated disc can irritate or compress a nearby nerve and cause symptoms such as:

• Lower-back pain
• Pain that travels into the buttock or leg
• Sciatica
• Numbness or tingling
• Muscle weakness

However, the presence of a disc herniation on an MRI does not necessarily mean it is responsible for the symptoms you are experiencing.

Don't Treat the MRI. Treat the Patient.

One of the most important parts of evaluating a spine condition is determining whether what appears on an MRI actually corresponds with the patient's symptoms. Research has shown that abnormalities can appear on spinal imaging even in people who have no back pain or sciatica at all.

In a landmark study published in The Journal of Bone and Joint Surgery, researchers performed lumbar MRIs on people without low-back pain, sciatica, or related symptoms. Approximately one-third had a substantial abnormality. Disc herniations were identified in 20% of participants younger than 60 and 36% of those age 60 or older. (PubMed)

Subsequent research has reinforced this concept. A systematic review involving more than 3,000 asymptomatic individuals found that many degenerative findings become increasingly common with age, even among people without pain. (PubMed)

That's why an MRI should be interpreted in context. A spine specialist considers your symptoms, physical examination, neurologic findings, medical history and imaging together to determine whether an abnormality is actually responsible for your problem.

The right treatment begins with the right diagnosis.

Can a Herniated Disc Get Better Without Surgery?

Yes. Many lumbar disc herniations can improve without an operation. 

A 2024 meta-analysis examining 31 studies and 2,233 patients treated conservatively found evidence of disc resorption in approximately 70% of patients overall. The likelihood varied considerably depending on the type of disc herniation, and most resorption occurred within the first six months of conservative treatment. (PubMed)

This doesn't mean that 70% of patients will become symptom-free or that every herniated disc should simply be observed, however it means that the natural history of a disc herniation is an important consideration when determining whether and when surgery is appropriate. Depending on the patient's condition, nonsurgical treatment may include options such as medication, activity modification, physical therapy or other treatments recommended by the patient's healthcare team.

If Surgery Can Help Faster, Why Wait?

Sometimes waiting isn't the right answer. Surgery can provide faster relief for appropriately selected patients with lumbar disc herniation and sciatica.

A randomized clinical trial comparing early surgery with prolonged conservative treatment in patients who had experienced severe sciatica for six to 12 weeks found that relief of leg pain occurred faster among patients assigned to early surgery. However, there was no significant overall difference in disability between the treatment groups during two years of follow-up. Of the patients assigned to conservative treatment, 44% ultimately underwent surgery within that period, which also means that more than half did not. (PubMed)

The goal isn't simply “surgery or no surgery.” It's determining the right treatment and timing for the individual patient.

When Might Surgery Be the Right Choice?

There are circumstances in which surgical treatment for a lumbar disc herniation may be appropriate, and situations in which more urgent evaluation is important. Factors that may influence the recommendation for surgery include:

• Persistent, disabling leg pain despite appropriate nonsurgical treatment
• Significant muscle weakness or motor deficit
• Progressive neurologic symptoms
• Symptoms that substantially interfere with daily activities and quality of life
• Clinical and imaging findings that clearly identify a surgically treatable cause

Certain symptoms require urgent medical evaluation. Every patient's circumstances are different. The potential benefits of surgery must be weighed against its risks and against the expected course without surgery.

If You Need Surgery, Which Technique Is Best?

Once surgery is determined to be appropriate, there is another question to answer: What is the right operation for this patient? Modern spine surgery offers multiple techniques and technologies, including:

• Endoscopic surgery
• Microscopic surgery
• Tubular/minimally invasive approaches
• Navigation and robotic-assisted techniques
• Traditional surgical approaches

New technology can offer meaningful benefits, but no single technique is right for every spine condition or every patient. The appropriate approach depends on factors such as the diagnosis, location of the problem, anatomy, neurologic findings, spinal stability and the goals of surgery. The surgical technique should follow the diagnosis, not the other way around.

The Right Spine Care Starts With the Patient

For Dr. Camden Whitaker, that decision-making process is at the heart of The Right Spine Care. His approach begins with understanding the individual patient, not just choosing a procedure. That means identifying what is actually causing the patient’s symptoms, determining whether surgery is necessary and, when surgery is appropriate, selecting the surgical approach best suited to the patient’s diagnosis, anatomy and needs.

Advanced techniques and technologies can play an important role in spine care, but they are tools, not the starting point. The goal is to use the right treatment, at the right time, for the right patient.

We don’t start with the operation. We start with the patient.

The Right Diagnosis → The Right Treatment → The Right Operation → The Right Spine Care

 

Have Questions About Your MRI or Treatment Options?

If you are experiencing back or leg pain, numbness, tingling, weakness or other spine-related symptoms, a comprehensive spine evaluation can help determine what may be causing your symptoms and which treatment options may be appropriate.

To get expert help for your back pain, don’t hesitate to call us to schedule a consultation. To schedule with Dr. Camden Whitaker, please call (316) 219-8299 or request an appointment online. 

 

 

References

Boden SD, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72(3):403–408. (PubMed)

Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. (PubMed)

Zou T, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-analysis. Clin Spine Surg. 2024;37(6):256–269. (PubMed)

Peul WC, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245–2256. (PubMed)

Lequin MB, et al. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open. 2013. (PubMed Central (PMC))