1) Are herniated discs able to heal up over time?
Lumbar discs go through a process of degeneration. They undergo chemical changes that result in the drying out of the disc. During this process the discs collapse, turn black, start to bulge and form bone spurs in order to attempt to fuse the disc in place. Though the blood supply to discs are poor in adults and rarely heal up internally, disc herniations (protrusions, sequestrations and extrusions) may heal up on their own, especially when they are large. The body’s inflammatory system may break them down relieving pressure off the nerves (unpinching the nerves). The pain you experience may remain stable, improve or worsen over time. There is significant work being done in stem cell research (adult mesenchymal stem cells) for disc regeneration and the early results are encouraging, showing improved disc height and fluid level. There are other surgical procedures that are being investigated, such as making holes in the disc endplates with an endoscope to improve the blood supply to the disk. This has been shown to help heal degenerated discs. Over the next few years there will likely be many new treatments for degenerative disc disease.
2) Is a discectomy a permanent solution?
Discectomy does not remove the entire disc, only the part of that is causing problems. Most patients do very well with the surgery, particularly if it is performed endoscopically. There is 10% chance of the disc recurring or regrowing. There is also risk of the disc degenerating, leading to back pain and the spine falling apart (called slipped spine or spondylolithesis) which also could require further surgery. Spine degeneration is rarely limited to one disc and often people have multiple discs wearing out and any of them or a new one may become a problem in the future.
3) What is the recovery time for a discectomy?
Recovery time depends on the type of discectomy surgery you have, how long you have had the problem, and the presence (or lack) of nerve damage. Patients recover quicker from minimally invasive and endoscopic discectomies than traditional open surgeries. People who have had the problem longer or who have nerve damage usually take longer to recover. Most people recover from surgery in between 2 and 12 weeks.
4) Is a herniated disc the same as a disc protrusion?
Disc herniation and disc protrusion are generalized terms for describing a disc displaced or sticking out of the disc space into the spinal canal. Disc protrusion may be used more specifically to describe a disc displacement when the height is less than the width. Since the terms for describing disc herniations vary from doctor to doctor and there is little consistency to how they are named, the best way to determine if your disc has worsened is by having a radiologist or back surgeon directly compare your MRI films.
5) For disc problems, is there an alternative to spinal fusion?
Endoscopic discectomy “laser spine surgery” is an alternative to spinal fusion for degenerative disc disease. The disc is removed through a pencil sized endoscope via an incision the size of a finger nail. There is decreased tissue damage, pain, and recovery time compared to spinal fusion.