How to Know When a Herniated Disc Requires Surgery
A herniated disc can turn simple movements into sharp, shooting pain. For some people, it feels like lightning in their legs or arm. For others, it is a deep ache that never fully let’s go.
The good news is that most herniated discs do not need surgery. Many people in San Diego improve with time, medication, injections, and physical therapy.
So how do you know when it is time to talk to a spine surgeon in San Diego about surgery for a herniated disc? Rather than guess, it helps to understand the signs that suggest nerve damage or failure of conservative care.
Quick Answer
Surgery for a herniated disc is usually considered when:
- Severe leg or arm pain from a confirmed herniated disc has lasted more than 6 to 12 weeks despite good non-surgical care, and is limiting daily life.
- You have progressive weaknesses, such as foot drop or trouble lifting your arm, that match nerve compression on MRI.
- You develop red flag symptoms, such as loss of bladder or bowel control or numbness in the saddle area, which may indicate cauda equina syndrome and require urgent surgery.
A herniated disc specialist in San Diego, such as a neurosurgeon or an orthopedic spine surgeon, will review your medical history, examination, and MRI results together before recommending surgery.
What Is a Herniated Disc
Your spine is made of bones called vertebrae, separated by discs that act as cushions. Each disc has a soft center and a tougher outer ring. A herniated disc occurs when part of the soft center protrudes through a tear in the outer layer and presses on nearby nerves.
Common locations:
- Cervical spine in the neck, which may cause neck pain and arm pain.
- Lumbar spine in the lower back, which may cause low back pain and sciatica leg pain.
Typical symptoms include:
- Local neck or back pain.
- Sharp, shooting pain down one arm or leg.
- Numbness or tingling in a specific area of the limb.
- Weaknesses in certain muscles supplied by the compressed nerve.
In San Diego, many patients meet a specialist after an MRI shows a disc pushing on a nerve. The next question is whether that finding explains the symptoms and what to do about it.
Why Most Herniated Discs Do Not Need Immediate Surgery
For many people, a herniated disc gradually improves. The body can reabsorb part of the disc and calm inflammation. Studies suggest that a large share of lumbar disc herniations improve within weeks to a few months without surgery.
Common non-surgical treatments in San Diego include:
- Activity modification: staying as active as possible but avoiding movements that sharply increase pain.
- Medications: anti-inflammatory drugs, short courses of other pain medicines when appropriate.
- Physical therapy: stretches, nerve glides, core and hip strengthening, posture training.
- Epidural steroid injections: in some cases, to reduce nerve inflammation and allow rehab.
As long as:
- Pain is slowly improving,
- You do not have major or worsening weakness,
- There are no bowel or bladder changes,
it is often reasonable to continue non-surgical care and give the disc more time to settle.
How Long Should You Try Conservative Care
There is no exact clock, but many guidelines and large spine centers use a similar framework:
- First 4 to 6 weeks: most acute herniated disc pain episodes improve with medication, therapy, and time.
- 6 to 12 weeks: if leg or arm pain remains severe and daily life is very limited despite good conservative care, it may be time to discuss surgery with a spine surgeon in San Diego.
- Any time: if red flag symptoms appear, you need urgent evaluation, not watchful waiting.
Herniated Disc Recovery and Decision Guideline Table
| Timeframe | Typical Course | Next Step Considerations |
| 0 to 6 weeks | Many herniated disc episodes improve with medication, PT, and activity changes | Continue non-surgical care if pain is trending in the right direction |
| 6 to 12 weeks | Some still have significant leg or arm pain despite good conservative care | Consider a surgical consult if pain is severe and function is limited |
| Any time (urgent) | New weakness, trouble walking, bowel or bladder changes, saddle numbness | Immediate specialist or ER evaluation, surgery may be urgent |
Guideline note: This table is a general guideline only. Decisions about herniated disc surgery depend on your specific symptoms, physical exam, MRI findings, overall health, and your specialist’s judgment.
Red Flag Symptoms: When a Herniated Disc Is an Emergency
Some symptoms mean you should not wait to see what happens. These may signal cauda equina syndrome or severe compression of the spinal cord or nerve roots.
Call emergency services or go to the ER right away if you notice:
- Loss of bladder or bowel control, or sudden trouble starting urination.
- Numbness in the groin, inner thighs, or saddle area.
- Rapidly worsening weakness in one or both legs, trouble walking, or frequent falls.
- Pain combined with fever, chills, or unexplained weight loss.
These situations can be surgical emergencies. Early decompression offers the best chance to protect nerve function.
Functional Red Flags: When Daily Life Is on Hold
Even if you do not have emergency signs, surgery can become a reasonable option when pain and disability reach a certain point. You may want to talk with a herniated disc surgeon in San Diego if:
- Pain is severe and constant enough that you:
- Cannot sleep through the night even with medication.
- Can only walk short distances before the pain becomes intense.
- Cannot sit or stand long enough to work, drive, or handle basic tasks.
- You have completed a full course of physical therapy, taken prescribed medications, and possibly tried injections, yet there is little or no improvement.
- You are missing significant work or important activities because of persistent leg or arm pain.
In many cases, leg or arm pain from nerve compression is a stronger reason for surgery than back pain alone. Surgery tends to be more reliable for radiating nerve pain than for pure axial back pain.
How MRI and Specialist Evaluation Guide the Decision
An MRI is very useful, but the image alone should not decide whether you need surgery. Many people have disc bulges or herniations that cause no symptoms at all.
A spine specialist in San Diego will look for alignment between three things:
- Your story
- Where the pain travels.
- What makes it better or worse.
- How long has it been going on.
- Your exam
- Muscle strength and reflexes in your arms or legs.
- Areas of numbness or tingling.
- Signs of nerve tension on specific tests.
- Your imaging
- Level and side of the herniated disc.
- How much does the disc compress the nerve root or spinal cord.
- Whether there are other problems, such as stenosis or instability.
When all three align, and non-surgical treatment has failed, or nerve function is at risk, herniated disc surgery in San Diego often becomes a sensible next step.
Common Surgical Options for a Herniated Disc
Your surgeon will choose a procedure based on the level, location, and severity of the herniation, as well as your overall health.
Lumbar microdiscectomy
- Often used for lumbar disc herniations that cause sciatica.
- The surgeon removes the part of the disc pressing on the nerve through a small opening.
- Many patients go home the same day or after an overnight stay, and leg pain relief can be quite fast when the nerve is decompressed.
Cervical discectomy
- For herniated discs in the neck that cause arm pain or spinal cord compression.
- May be done as ACDF (anterior cervical discectomy and fusion) or artificial disc replacement in select patients.
- The goal is to relieve pressure on the spinal cord and nerve roots and stabilize the spine.
Some surgeons in San Diego also use minimally invasive approaches, such as tubular retractors and smaller incisions, for selected lumbar herniated disc cases. The underlying goal is the same: free the nerve from compression.
What Surgery Can and Cannot Do
It is important to have realistic expectations before any operation.
What herniated disc surgery can often do:
- Provide faster relief of leg or arm pain compared with continued non-surgical care when nerve compression is clear.
- Prevent further nerve damage in cases of progressive weakness, foot drop, or cord compression.
What surgery cannot guarantee:
- Complete removal of all back or neck pain.
- A “brand new” spine or prevention of future degeneration.
- Perfect restoration of sensation or strength if the nerve has been compressed for a long time.
Many patients still have some stiffness or mild residual numbness after recovery. The realistic goal is meaningful improvement in pain and function, not perfection.
Questions To Ask a Herniated Disc Surgeon in San Diego
Before deciding on surgery, it helps to ask clear questions, such as:
- What is the exact level and side of my herniated disc
- Do my symptoms and exam match what you see on my MRI
- What non-surgical treatments have I tried, and have I done enough of them
- What are the realistic goals of surgery in my case
- What are the main risks and possible complications
- How long is the expected recovery, and when can I return to work and exercise
- Are there minimally invasive options for my situation
You can also ask if a second opinion in San Diego would be helpful. Many spine surgeons support this, especially for big decisions.
Final Thoughts
Most people with a herniated disc in the neck or lower back will never need surgery. Time, therapy, and smart activity changes often allow the body to heal on its own.
You should start thinking seriously about herniated disc surgery in San Diego when:
- Severe radiating pain has lasted more than 6 to 12 weeks despite good conservative care.
- Weakness is getting worse, or daily life is on hold.
- Emergency symptoms such as bowel or bladder changes or saddle numbness appear.
A thoughtful evaluation with a trusted spine specialist can help you decide whether to stay the course with non-surgical treatment or move toward surgery to protect your nerves and improve your quality of life.
Key Takeaways
- A herniated disc occurs when disc material presses on nerves, causing back or neck pain and often leg or arm pain.
- Most herniated discs improve without surgery within a few weeks to months.
- Surgery is usually considered when pain remains severe after 6 to 12 weeks of good conservative care, or when there is progressive weakness or red flag symptoms.
- MRI findings must match your symptoms and exam before surgery makes sense.
- A spine surgeon in San Diego can help you weigh non-surgical care against microdiscectomy or cervical discectomy when nerve function and quality of life are at stake.
If you are struggling with persistent leg or arm pain from a known herniated disc and are unsure whether it is time to consider surgery, you can schedule a consultation with Dr. Sanjay Ghosh in San Diego for a detailed review of your MRI, symptoms, and options.
Dr. Sanjay Ghosh is a board-certified neurosurgeon at SENTA Clinic in San Diego, fellowship trained in complex spine and cranial base surgery. This content is educational and not a substitute for personalized medical advice.
Reference Links:
- General overview, causes, symptoms, when surgery is needed
- Natural history, conservative care vs surgery for lumbar disc herniation
- Guidance on when surgery is considered, red flag symptoms
- Microdiscectomy indications, expected outcomes, and recovery
- Evidence comparing early surgery vs prolonged conservative treatment