When Would a Spine Surgeon Have Surgery for a Herniated Disc?

Introduction Surgical indications are not always clear cut and patients need to participate in the process of making an informed decision, weighing the potential risks, and benefits to have surgery or not. This decision is likely heavily influenced based on their pain level, work, and activity limitations. There is much information available on the outcomes and complications of surgery for lumbar disc herniation. The purpose of this study was to determine for which indications spine surgeons would have surgery themselves. Materials and Methods A survey was designed using Survey Monkey, which ensures responses are anonymous. The survey was sent to the ISASS surgeon membership. The survey collected basic demographics. The scenario for seeking treatment was that if you had sciatica with a 5 mm disc herniation identified on MRI and pain at the confirmed level, when would you consider some form of direct decompressive surgery? The second set of questions addressed if in the same circumstances and having failed nonoperative care, separately assessed pain level, work limitation level, and nonwork activity limitation level for which the surgeon would have spine surgery to treat the herniated disc. Results There were 67 responses to the survey. The majority of those completing the survey were in the age ranges of 45 to 54 years (40.3%) and 55 to 64 years (35.8%). The most frequent response selected to the question about the number of years in practice was 21 to 30 years (43.3%). More than half selected one of the two categories indicating performing between 100 and 300 spine surgeries a year. The majority of responses came from members in the United States, but there were participants from Canada, Australia, Europe, and Asia. Responses to the question about having surgery for a 5 mm herniation indicated that 75.8% of surgeons would have surgery if they had buttock and leg pain below the knee that limited work activities 2 of 5 days so that on those 2 days you had to stop after half day of work. Less than 20% would have surgery if symptoms interfered with nonwork activities, but not work. Of note, 18.2% indicated that they would not have surgery for the herniated disc regardless of the symptoms experienced. The second series of questions separately assessed pain, work, and nonwork activities. With respect to pain intensity, on a 0 to 10 scale, 63.6% would have surgery for scores of 7 to 10. With respect to work, 39.4% indicated they would have surgery if experiencing continual pain at work, 34.8% would have surgery if able to work only half days, and 19.7% would have surgery only if they were unable to work at all. Partial limitation of activities would lead 28.4% of respondents to have surgery, while 68.7% would have surgery if their activities were severely limited. Discussion The results of this survey found that many spine surgeons would have surgery if the pain was 7 or greater on a scale of 10, they continually experienced pain during work or had severely limited activities. Interestingly, 18.2% indicated they would not have surgery regardless of symptoms.

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