When Should a Herniated Disc Be Operated On?
A herniated disc is one of the most common spinal conditions. In France alone, approximately 30,000 patients undergo surgery each year for lumbar disc herniation, while 120,000 are treated conservatively. But the vast majority of herniated discs heal without surgery. So when does an operation become necessary?
Dr Christian Dimitriu, a neurosurgeon specialising exclusively in spinal surgery, answers the most frequent questions from his patients.
Most herniated discs heal without surgery
This is a well-established medical fact: 60 to 90% of patients suffering from sciatica caused by a herniated disc improve within 6 to 12 weeks with conservative treatment. The herniation resolves spontaneously in more than two thirds of cases.
Conservative treatment includes:
• Relative rest (no strict bed rest — staying active is important)
• Pain relief medication and anti-inflammatory drugs
• Physiotherapy and muscle strengthening
• Epidural injections for persistent pain
Dr Dimitriu systematically prioritises conservative treatment. Surgery is only proposed after failure of well-conducted medical treatment for 6 to 8 weeks, or in cases of neurological emergency.
3 situations where surgery is urgent
Fewer than 10% of symptomatic herniated discs require an operation. But certain situations constitute surgical emergencies:
1. Cauda equina syndrome
This is the absolute emergency in spine neurosurgery. The herniation compresses the cauda equina nerves, causing urinary disturbances (difficulty urinating or incontinence), loss of sensation in the perineal area and weakness in both legs. The patient must be operated on within hours to prevent permanent damage.
2. Paralysing sciatica
When the herniation severely compresses a nerve root, the patient progressively loses strength in the foot, ankle or knee. A worsening motor deficit is an urgent surgical indication, as a nerve compressed for too long may not fully recover.
3. Hyperalgesic sciatica
Unbearable pain that resists all medical treatments, including morphine and injections, constitutes a surgical indication. The patient can no longer sleep, work or even move around.
Non-urgent indications for surgery
Outside these emergencies, surgery is considered after well-conducted conservative treatment for 6 to 8 weeks without sufficient improvement:
• Persistent and disabling pain despite 2 to 3 injections
• Major impact on quality of life (prolonged sick leave, inability to walk normally)
• Correlation between clinical symptoms and imaging (MRI or CT scan)
• Stable but bothersome sensory or motor deficit
Dr Dimitriu emphasises: “The MRI does not decide the operation. It is the correlation between what the patient experiences and what the imaging shows that guides the decision. A herniation visible on MRI but asymptomatic requires no treatment.”
How is the operation performed?
The standard procedure is microdiscectomy: the surgeon removes the disc fragment compressing the nerve through a 3 to 4 centimetre incision, under a microscope. The operation takes 30 to 45 minutes under general anaesthesia.
Results are excellent: sciatic pain disappears upon waking in the majority of cases. The patient stands up the same day and goes home within 24 to 48 hours.
Minimally invasive and endoscopic techniques, with an incision of less than one centimetre, allow even faster recovery. Day surgery (returning home the same day) is possible for simple herniations.
Frequently asked questions
The complication rate for microdiscectomy is very low (approximately 2-3%). The main risks are surgical site infection (< 1%) and disc reherniation (5-10% long-term). Serious neurological risk is exceptional.
For office work: 2 to 4 weeks. For physical work: 6 to 12 weeks. Driving can resume from 3 to 4 weeks.
The recurrence risk is 5 to 10% long-term. Core strengthening, good posture habits and stopping smoking reduce this risk.
Loss of strength in the foot or leg, urinary problems (difficulty urinating), loss of sensation in the perineal area. These signs constitute neurosurgical emergencies.
Dr Dimitriu is a neurosurgeon specialising exclusively in spinal surgery. Former University Hospital Senior Registrar and Certified Military Practitioner, he is a member of 8 international learned societies (EANS, AOSpine, SFNC, EuroSpine) and author of 36 scientific publications. He practises in 4 clinics across Île-de-France and offers teleconsultation.
Sources: Santé publique France (PMSI 2022), HAS (2025), SFCR, EANS.