Exploring Herniated Disc Surgery: Understanding Disc Herniation

Why Is Disc Herniation Surgery Success Rate 50%?- Toronto Downtown Chiropractor

Considering Herniated Disc Surgery?

If you’re contemplating herniated disc surgery for your lower back, it’s crucial to arm yourself with all the necessary information. Many individuals rush into decisions about low back disc surgery without fully understanding the complexities involved.

Why Do Some Low Back Herniated Disc Surgeries Fail?

A common misconception is attributing all lower back pain to visible bulging discs on MRI scans. This assumption is widespread among medical professionals, including doctors, chiropractors, and radiologists. However, identifying the true cause of lower back pain is more complex than just diagnosing a bulging disc on an MRI.

The Misunderstanding of MRI Findings: Herniated Disc Surgery

The reliance on MRI results to pinpoint the source of lower back pain can lead to misdiagnoses. While a bulging disc might seem like the obvious culprit, it’s not always the root cause of discomfort. This misunderstanding can result in unnecessary or unsuccessful surgeries.

Key Insights:

  • Informed Decision-Making: Before considering surgery, it’s essential to explore all underlying factors of lower back pain.
  • Beyond the Bulge: Understand that not all back pain originates from disc issues visible on an MRI.
  • Seek Comprehensive Evaluation: Consult with healthcare providers who take a holistic approach to diagnose and treat lower back pain.

Making an Informed Decision:

Making an informed decision about herniated disc surgery for your lower back requires understanding the complexities behind disc herniation and its diagnosis. It’s important to consider that a bulging disc on an MRI does not automatically equate to the source of lower back pain. By seeking thorough evaluations and considering all potential causes, patients can avoid the pitfalls of unnecessary surgeries and move towards more effective treatment options.

An MRI stands for Magnetic Resonance Imaging. The problem with MRIs is that almost no single person has a completely normal MRI. “It is very rare for an MRI to come back with the words “normal study,“ said Dr. Christopher DiGiovanni, a professor of orthopaedics and a sports medicine specialist at Brown University. “I can’t tell you the last time I’ve seen it.”

So if your doctor or chiropractor tells you, you have a disc bulge based on an MRI you need to think.

  • Did my doctor do a thorough examination?
  • Did my doctor do a neurological examination including reflexes, light touch and muscle testing?
  • Did your doctor have a diagnosis in mind before sending you for an MRI? ie Did your doctor tell you what your pain is caused by, before sending you off for an MRI?

Not all disc herniations cause pain!

CT scan-Doctor viewing CT scan

Disc herniations occur in stages

  1. Disc Bulge
  2. Disc Protrusion
  3. Disc Herniations / Extrusion
  4. Disc Sequestration

Here are three good studies that prove that what you see on MRI is not always proof that your lower back pain is from disc herniation.

See Also: Disc Herniation Treatments Part 1

#1  MRI imaging of the lumbar spine in people without back pain: Herniated Disc Surgery

New England Journal of Medicine – 1994; 331:369-373 [1].

  • This well-designed study examined 98 people with no pain or symptoms.
  • 52% had a disc bulge on MRI.
  • 27% had a disc protrusion.
  • 1% had a disc extrusion.
  • Total: 80% had a disc bulge, protrusion or extrusion
  • Does this mean you need herniated disc surgery?

#2 MRI of the lumbar spine: Disc extrusion and sequestration, in Asymptomatic Volunteers.

Radiology – 1998; 209:661-666 [2].

  • 60 people with no low back problems with an average age of 35 years were examined by MRI.
  • 24% had a disc bulge.
  • 40% had a disc protrusion.
  • 18% had a disc extrusion.
  • Total: 82 % had a disc bulge, protrusion or extrusion.
  • Does this mean you need herniated disc surgery?

#3 The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying asymptomatic disc herniations.

Spine – 1995; 20:2613-2625 [3].

  • 46 “high-risk” people with jobs that increase the risk of disk herniation with frequent bending, twisting and heavy lifting were tested with an MRI.
  • All 46 had no low back problems.
  • 76% of these “high-risk” people had at least one disc protrusion or extrusion.
  • Does this mean you need herniated disc surgery?

The takeaway here is that your doctor may diagnose your problem incorrectly saying that your lower back pain is due to your disc herniation when it may not be the case. Just because you can see a disc on MRI doesn’t mean it is causing you pain. The results must correspond with the history and clinical examination.

See Also: Is an MRI, CT or X-ray Best For My Pain?

Doctors, physiotherapists and chiropractors are increasingly relying on technology instead of taking a good history and a proper neurological, and physical examination.

Tell us what you think in the comments below and like us on Facebook. This Toronto Downtown Chiropractor will answer all questions in the comments section.


[1] Boden SD et al “MRI imaging of the lumbar spine in people without back pain.”, New England Journal of Medicine – 1994; 331:369-373.

[2] Weishaupt D et al. “MRI of the lumbar spine: Prevalence of intervertebral disc extrusion and sequestration, nerve root compression and plate abnormalities, and osteoarthritis of the fact joints in Asymptomatic Volunteers.” Radiology – 1998; 209:661-666.

[3] Boos N, et al. “1995 Volvo Award in clinical science: The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying symptomatic disc herniations.” Spine – 1995; 20:2613-2625.

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  • I am lumbar spinal stenosis sufferer since last Sept. I have low back pain and mild cramping on the right low leg near the ankle area. I cannot stand or walk for more than 5 minutes. I have the MRI report and L4-L5 disc images that shows “moderate sized central disc protrusion at L4-L5 causing a mild degree of spinal canal central stenosis”. Will I be benefited for chiropractic treatments or surgery. I have seen two chiropractors so far have very little effect. Please advise.

  • I am a chronicle back pain patient, since end of May, I have drop foot. From recent MRI report, I was informed there is 2.5 centimeter disc herniation on L3 and L4. I am waiting for further nerve test and neurosurgeon appointment. My physiatrist advised me not to do McKenzie exercise, as the size of the herniation disc. If you exercise that you can suggest me to push the disc back? Thanks.

    • Post

      Thanks for your comment Chow. You are absolutely right you should not do McKenzie exercises when you have such a large herniation. Your only option looks like surgery or injections. I would schedule surgery and get the injection while waiting for surgery unless surgery can be scheduled in less than a month.

  • Please explain, if it is NOT A herniated disc protruding into foramen space and compressing nerve, (L4L5?) what would cause leg and hip pain(sciatic pain) or 6 months?(not piriformus syndrome) what else? Chronically swollen nerves? eg from poor lifting/bending etc.

Dr Ken Nakamura downtown Toronto Chiropractor
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Dr. Ken, has been recognized as the Best Toronto Chiropractor in 2024, 2023, and 2018, here in downtown Toronto. As a sports chiropractor, he excels in treating a wide range of conditions including concussions, temporomandibular joint disorders (TMJ), sports-related injuries, and spinal issues. Beyond his clinical skills, Dr. Ken is an accomplished athlete, having represented Ontario in the Canadian Judo Championships and completed the Toronto Marathon on two occasions. He employs the innovative C3 Program to provide targeted and effective care to his patients, ensuring a holistic approach to their well-being and athletic performance.