Why Is Disc Herniation Surgery Success Rate Only 50%?

By Dr Ken Nakamura+

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

Are you considering getting surgery for your low back?


Would you like to know why many low back disc surgeries fail?


Most people think that an bulging disc on an MRI means, that is the cause of their low back pain. This mistake is made by doctors, chiropractors and radiologists alike.



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 orthopedics 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 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 an 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 low back pain is from the disc herniation.

See Also: Disc Herniation Treatments Part 1

#1  MRI imaging of the lumbar spine in people without back pain.


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


#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.


#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.



The take away 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 means 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 increasing 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.



Dr Ken Nakamura

6 Responses to Why Is Disc Herniation Surgery Success Rate Only 50%?
  • R. Chan says:
    February 16, 2016 at 1:34 am

    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.

  • AP Chow says:
    June 30, 2014 at 2:29 am

    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.

    • Dr Ken Nakamura says:
      July 3, 2014 at 10:42 pm

      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.

  • Kay Dannatt says:
    February 10, 2014 at 12:36 pm

    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 says:
      February 10, 2014 at 10:38 pm

      Thanks for your question Kay. While a herniated disc is a common cause of pain that radiates into the hip and leg there are other common problems that can cause sciatica. Osteoarthritis of the discs called degenerative disc disease or osteoarthritis of the joints cause bony spurs that encroach on the nerve. This is called stenosis.

      There is also spinal stenosis which is caused by compression of the nerves where the spinal cord is. (Usually more common in the 60 years and older)

      Then there is spondylolisthesis and spondylolysis. Spondylolysis (fracture of vertebra) (different from spondylosis) is when the vertebrae fracture either from trauma but also commonly from degeneration. Spondylolisthesis is a movement of the top vertebrae forward due to the spondylolysis (fracture of vertebrae)

      I recommend you read two articles. The first is on sciatica. This explains all the causes of sciatica. https://www.bodiempowerment.com/low-back-pain/sciatica-4-best-exercises/

      The second article I recommend is on avoiding the everyday things that cause you pain aimed at people with a disc herniation. https://www.bodiempowerment.com/low-back-pain/disc-herniation-part-1/

      If you want the disc herniation exercises here is part II Herniated disc: https://www.bodiempowerment.com/low-back-pain/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/

      If you have any more questions let me know.

      Hope that helps!

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