{"id":66023,"date":"2026-04-16T08:00:29","date_gmt":"2026-04-16T06:00:29","guid":{"rendered":"https:\/\/mivisalud.com\/blog\/when-is-it-necessary-to-operate-on-a-herniated-disc-current-medical-criteria\/"},"modified":"2026-07-29T10:55:36","modified_gmt":"2026-07-29T08:55:36","slug":"when-is-it-necessary-to-operate-on-a-herniated-disc-current-medical-criteria","status":"publish","type":"post","link":"https:\/\/mivisalud.com\/en\/blog\/when-is-it-necessary-to-operate-on-a-herniated-disc-current-medical-criteria\/","title":{"rendered":"When is it necessary to operate on a herniated disc? Current medical criteria"},"content":{"rendered":"<p><span data-contrast=\"auto\">The word <\/span><b><span data-contrast=\"auto\">&#8220;herniated disc&#8221;<\/span><\/b><span data-contrast=\"auto\">  is frightening. And it is normal: it is usually associated with intense pain, sciatica, limitation and, many times, an automatic idea: &#8220;I&#8217;m going to have to have surgery&#8221;. <\/span><\/p>\n<p><span data-contrast=\"auto\">But the current clinical reality is different: <\/span><b><span data-contrast=\"auto\">the majority of herniated discs do not require surgery<\/span><\/b><span data-contrast=\"auto\"> and improve with well-indicated conservative management.<\/span><\/p>\n<p><span data-contrast=\"auto\">In this article we explain <\/span><b><span data-contrast=\"auto\">when it is necessary to operate a herniated disc<\/span><\/b><span data-contrast=\"auto\">what are the current <\/span><b><span data-contrast=\"auto\">current medical criteria<\/span><\/b><span data-contrast=\"auto\">what signs indicate urgency and what options are available before going to the operating room.<\/span><\/p>\n<p><b><span data-contrast=\"auto\">When to operate a herniated disc? Current medical criteria | MIVI Salud <\/span><\/b><\/p>\n<p><b><span data-contrast=\"auto\">Find out when it is necessary to operate on a herniated disc: symptoms, current medical criteria, warning signs (cauda equina, neurological deficit), timing and alternatives.<\/span><\/b><\/p>\n<p><b><span data-contrast=\"auto\">What is a herniated disc and why does it not always hurt?<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">Between the vertebrae there are intervertebral discs that act as shock absorbers. We speak of   <\/span><b><span data-contrast=\"auto\">herniated disc<\/span><\/b><span data-contrast=\"auto\"> when part of the disc is displaced and can irritate or compress <\/span><b><span data-contrast=\"auto\">irritate or compress<\/span><\/b><span data-contrast=\"auto\"> a nerve root.<\/span><\/p>\n<p><span data-contrast=\"auto\">Key points (very important to understand the treatment):<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">You can have a herniated disc on an MRI scan <\/span><b><span data-contrast=\"auto\">without pain<\/span><\/b><span data-contrast=\"auto\">.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">You can have low back or neck pain <\/span><b><span data-contrast=\"auto\">without a herniated disc<\/span><\/b><span data-contrast=\"auto\">.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">What guides medical decisions is not only the image, but also the clinical <\/span><b><span data-contrast=\"auto\">clinical (symptoms) + neurological examination + evolution.<\/span><\/b><span data-contrast=\"auto\">.<\/span><\/li>\n<\/ul>\n<p><b><span data-contrast=\"auto\">Is it necessary to operate a herniated disc? Most frequently: no <\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">In current medical practice, surgery is reserved for specific situations. In most cases, conservative treatment is prioritized because: <\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"3\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">many pictures improve within weeks,<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"3\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">pain can be controlled without surgery,<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"3\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">and operating without clear criteria brings no benefit (and risks).<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">Simply put: <\/span><b><span data-contrast=\"auto\">you trade when the risk of not trading is greater than the risk of trading.<\/span><\/b><span data-contrast=\"auto\">.<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Current medical criteria for herniated disc surgery<\/span><\/b><\/p>\n<p><b><span data-contrast=\"auto\">1) Urgent surgery: cauda equina syndrome.<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">It is the most important scenario and requires immediate attention. It may present with: <\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"4\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">loss of sphincter control (urine or stool),<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"4\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">numbness in the perineal area (&#8220;saddle&#8221;),<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"4\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">marked weakness in legs,<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"4\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"auto\">bilateral pain or progressive neurological symptoms.<\/span><\/li>\n<\/ul>\n<p><b><span data-contrast=\"auto\">In this case, there is no waiting:<\/span><\/b><span data-contrast=\"auto\"> priority action is taken because time influences neurological recovery.<\/span><\/p>\n<p><b><span data-contrast=\"auto\">2) Progressive neurological deficits (loss of strength).<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">If the herniated disc causes <\/span><b><span data-contrast=\"auto\">weakness<\/span><\/b><span data-contrast=\"auto\"> (e.g., &#8220;I drop my foot,&#8221; &#8220;I can&#8217;t lift my toe,&#8221; obvious loss of strength in a muscle) and that weakness is progressive or significant, surgery may be indicated.<\/span><\/p>\n<p><span data-contrast=\"auto\">Here the criterion is clear: <\/span><b><span data-contrast=\"auto\">the objective is not only to soothe pain<\/span><\/b><span data-contrast=\"auto\">but to <\/span><b><span data-contrast=\"auto\">to protect the nerve<\/span><\/b><span data-contrast=\"auto\">.<\/span><\/p>\n<p><b><span data-contrast=\"auto\">3) Disabling pain that does not improve with conservative treatment.<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">This is the most common scenario when surgery is planned on a scheduled basis:<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"5\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Severely limiting pain (low back, cervical, sciatica or brachialgia)<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"5\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">No improvement after a reasonable period of well-conducted non-surgical treatment<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"5\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">And with correlation between symptoms, examination and imaging findings.<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">The &#8220;reasonable time&#8221; varies from case to case, but is generally considered to be between <\/span><b><span data-contrast=\"auto\">6 to 12 weeks<\/span><\/b><span data-contrast=\"auto\">  (or earlier if the disability is extreme and persistent). The final decision must always be individualized. <\/span><\/p>\n<p><b><span data-contrast=\"auto\">4) Frequent recurrences with great functional impact.<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">In some individuals, the episodes recur frequently, result in prolonged sick leave and deteriorate quality of life, despite proper treatment. In these cases, surgery may also be considered, especially if there is a clear clinical pattern and concordant evidence. <\/span><\/p>\n<p><b><span data-contrast=\"auto\">Difference between lumbar disc herniation and cervical disc herniation<\/span><\/b><\/p>\n<p><b><span data-contrast=\"auto\">Lumbar disc herniation<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">It usually manifests itself as:<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">lumbar pain,<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"2\" data-aria-level=\"1\"><b><span data-contrast=\"auto\">sciatica<\/span><\/b><span data-contrast=\"auto\"> (pain that goes down the buttock and leg),<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">tingling, cramps or loss of sensation,<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"auto\">sometimes loss of strength.<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">Surgery is proposed mainly for <\/span><b><span data-contrast=\"auto\">neurological deficit<\/span><\/b><span data-contrast=\"auto\"> o <\/span><b><span data-contrast=\"auto\">persistent disabling sciatica<\/span><\/b><span data-contrast=\"auto\">.<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Cervical disc herniation<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">May cause:<\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"7\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">cervical and arm pain (brachialgia),<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"7\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">tingling in hand,<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"7\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">loss of strength,<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"7\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"auto\">and in some cases signs of spinal cord involvement (myelopathy).<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">If there is <\/span><b><span data-contrast=\"auto\">spinal cord compression<\/span><\/b><span data-contrast=\"auto\"> or symptoms compatible with <\/span><b><span data-contrast=\"auto\">myelopathy<\/span><\/b><span data-contrast=\"auto\">the approach is usually a higher priority.<\/span><\/p>\n<p><b><span data-contrast=\"auto\">What options are available before operating on a herniated disc?<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\">For many patients, the right path is not to &#8220;tough out&#8221; the pain, but to follow a well-structured plan. Depending on the case, it may include: <\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"8\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Education and control of fear of movement<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"8\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">Physiotherapy and therapeutic exercise (progressive and specific)<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"8\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">Analgesia according to medical criteria<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"8\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"auto\">Infiltrations or interventional techniques in selected cases<\/span><span data-ccp-props=\"{\"134233117\":true,\"134233118\":true,\"201341983\":0,\"335559740\":240}\"> (with Local Anesthetics and Corticoids, Ozone, Platelet Rich Plasma -PRP-, Laser, etc.).<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"8\" data-aria-posinset=\"5\" data-aria-level=\"1\"><span data-contrast=\"auto\">Rehabilitation aimed at recovering function and preventing relapses.<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">A key point: <\/span><b><span data-contrast=\"auto\">If pain prevents you from moving, sleeping or working<\/span><\/b><span data-contrast=\"auto\">It is not necessary to chronify it. There are medical options to improve pain control and facilitate functional recovery. <\/span><\/p>\n<p><b><span data-contrast=\"auto\">What evidence is needed to decide?<\/span><\/b><\/p>\n<p><span data-contrast=\"auto\"><em>MRI and radiography are useful tools&#8221;<\/em> and details <em>&#8220;Imaging (maximum extension and flexion CXR, Nuclear Magnetic Resonance Imaging) when indicated:<\/em><\/span><\/p>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"9\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Medical history (type of pain, irradiation, limitation)<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"9\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">Neurological examination (reflexes, sensitivity, strength).<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"9\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">Time evolution<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\" data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"9\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"auto\">Imaging (MRI) when indicated<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-setsize=\"-1\"><span data-contrast=\"auto\">Real functional impact on daily life<\/span><\/li>\n<\/ul>\n<p><b><span data-contrast=\"auto\">Summary: when is it recommended to operate on a herniated disc?<\/span><\/b><\/p>\n<p><b><span data-contrast=\"auto\">Surgery is considered when:<\/span><\/b><\/p>\n<ol>\n<li aria-setsize=\"-1\" data-leveltext=\"%1.\" data-font=\"Golos Text,Times New Roman\" data-listid=\"10\" data-list-defn-props=\"{\"335552541\":0,\"335559685\":720,\"335559991\":360,\"469769242\":[65533,0],\"469777803\":\"left\",\"469777804\":\"%1.\",\"469777815\":\"multilevel\"}\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">There is <\/span><b><span data-contrast=\"auto\">cauda equina syndrome<\/span><\/b><span data-contrast=\"auto\"> (urgency).<\/span><\/li>\n<\/ol>\n<ol>\n<li aria-setsize=\"-1\" data-leveltext=\"%1.\" data-font=\"Golos Text,Times New Roman\" data-listid=\"10\" data-list-defn-props=\"{\"335552541\":0,\"335559685\":720,\"335559991\":360,\"469769242\":[65533,0],\"469777803\":\"left\",\"469777804\":\"%1.\",\"469777815\":\"multilevel\"}\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"auto\">There is <\/span><b><span data-contrast=\"auto\">significant or progressive<\/span><\/b><span data-contrast=\"auto\"> progressive loss of strength.<\/span><\/li>\n<\/ol>\n<ol>\n<li aria-setsize=\"-1\" data-leveltext=\"%1.\" data-font=\"Golos Text,Times New Roman\" data-listid=\"10\" data-list-defn-props=\"{\"335552541\":0,\"335559685\":720,\"335559991\":360,\"469769242\":[65533,0],\"469777803\":\"left\",\"469777804\":\"%1.\",\"469777815\":\"multilevel\"}\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"auto\">There is <\/span><b><span data-contrast=\"auto\">disabling pain<\/span><\/b><span data-contrast=\"auto\"> that does not improve after adequate conservative treatment.<\/span><\/li>\n<\/ol>\n<ol>\n<li aria-setsize=\"-1\" data-leveltext=\"%1.\" data-font=\"Golos Text,Times New Roman\" data-listid=\"10\" data-list-defn-props=\"{\"335552541\":0,\"335559685\":720,\"335559991\":360,\"469769242\":[65533,0],\"469777803\":\"left\",\"469777804\":\"%1.\",\"469777815\":\"multilevel\"}\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"auto\">There is <\/span><b><span data-contrast=\"auto\">recurrences<\/span><\/b><span data-contrast=\"auto\"> with great functional impact and concordant clinical criteria.<\/span><\/li>\n<\/ol>\n<p><span data-contrast=\"auto\">In most cases, herniated discs are initially managed without surgery. <\/span><b><span data-contrast=\"auto\">without surgery<\/span><\/b><span data-contrast=\"auto\">with an appropriate medical and rehabilitative approach.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b><span data-contrast=\"auto\">Author<\/span><\/b><\/p>\n<p><b><span data-contrast=\"auto\">Dr. Nicol\u00e1s Sarri\u00e1<\/span><\/b><\/p>\n<p><i><span data-contrast=\"auto\">Pain Unit &#8211; MIVI M\u00e1laga | MIVI Salud<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The word &#8220;herniated disc&#8221; is frightening. And it is normal: it is usually associated with intense pain, sciatica,&hellip;<\/p>\n","protected":false},"author":23,"featured_media":65448,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":"","_ppma_block_editor_authors":""},"categories":[976,1004],"tags":[],"ppma_author":[1404],"class_list":["post-66023","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-pain","category-back-pain","author-dr-nicolas-sarria"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u25b7 When is it necessary to operate on a herniated disc? Current medical criteria | Mivi<\/title>\n<meta name=\"description\" content=\"When to operate a herniated disc? 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