腰椎间盘突出症

A lumbar disc herniation means one of the “cushions” between the bones in the lower back has torn and some of the soft center has bulged out, pressing on nearby nerves. This can cause low‑back pain and often sharp, shooting pain, tingling, or weakness down one leg (often called sciatica).​

1) What is this condition?

  • Each disc has a tough outer ring and a soft inner core; a herniation happens when the outer ring cracks and the inner material pushes out.​

  • The leaked material can irritate or compress nerves in the spinal canal, causing pain and nerve symptoms in the buttock, leg, and sometimes foot.​

2) How serious is it?

  • Most herniated discs are painful but not dangerous, and many improve with time and non‑surgical care.​

  • Red‑flag signs needing urgent care include: trouble controlling bladder or bowels, numbness in the groin/saddle area, or rapidly worsening leg weakness.​

3) Non‑surgical treatments

  • Short period of relative rest, but staying gently active rather than strict bed rest.​

  • Medicines:

    • Anti‑inflammatory drugs, pain relievers, sometimes muscle relaxants or nerve‑pain medicines.​

  • Physical therapy:

    • Guided exercises (often extension‑ or McKenzie‑based), stretching, core strengthening, posture and lifting training.​

  • Injections:

    • Epidural steroid injections to reduce inflammation and leg pain in selected patients.​

4) Possible surgery

  • Lumbar discectomy or microdiscectomy: removing the part of the disc that is pressing on the nerve, usually through a small opening.​

  • Sometimes combined with a small laminectomy (removing part of the bone “roof”) to access the disc; fusion is rarely needed for a first‑time, single‑level herniation.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Manage pain, keep you functioning, and let the disc and nerve calm down naturally, since many herniations shrink or dry out over time.​

  • Surgery goals:

    • Relieve pressure on the nerve more quickly, especially when there is severe or persistent leg pain, weakness, or loss of function despite good conservative care.​

6) How surgery will fix the problem

  • The surgeon removes the fragment of disc that has escaped and any loose debris, creating more space for the nerve root.​

  • This usually reduces the chemical irritation and mechanical squeezing of the nerve, which can ease leg pain quickly and allow the nerve to recover.​

7) Risks of surgery (general and specific)

  • General: infection, bleeding, blood clots, anesthesia or heart/lung complications.​

  • Spine‑specific:

    • Dural tear (spinal fluid leak), nerve injury causing new or worse weakness or numbness, and very rarely loss of bladder/bowel control.​

8) Chances this surgery will work

  • Most patients have substantial relief of leg pain and improved function after microdiscectomy; one study found only about 4% had worse function a year later.​

  • Large cohort studies show surgery offers faster symptom relief than non‑surgical care in the first months, and somewhat better improvement over years for people with moderate–severe sciatica.​

9) Possible complications from surgery

  • Short‑term: wound infection, discitis (disc infection), spinal fluid leak, hematoma, or persistent pain.​

  • Long‑term: lack of pain relief, ongoing numbness, recurrent disc herniation at the same level (roughly 5–15% in many series), or need for repeat surgery or later fusion.​

10) Typical recovery from the condition (without surgery)

  • Many people improve noticeably within 6 weeks; up to about 90% may get better without surgery in some series.​

  • By 3–4 months, most are largely symptom‑free or much improved, though some may have intermittent flares.​

11) Typical recovery after surgery

  • Leg pain often improves within days; back soreness at the incision is common for a few weeks.​

  • Light activities and walking begin almost immediately; heavier lifting, bending, and sports are usually limited for several weeks to a few months.​

  • Numbness or weakness may recover more slowly and may not fully normalize if the nerve was badly compressed for a long time.​

12) How long in the hospital

  • Many microdiscectomies are done as same‑day surgery or with a single overnight stay if recovery is uncomplicated.​

13) Long‑term outlook

  • Most people with a single‑level lumbar disc herniation return to normal or near‑normal activities, whether treated surgically or non‑surgically.​

  • Some remain prone to episodic low‑back pain or sciatica, especially if risk factors (smoking, heavy lifting, obesity, deconditioning) are not addressed.​

14) Need for outpatient follow‑up

  • Non‑surgical: follow‑up to monitor pain, strength, and function, adjust medicines and therapy, and reconsider imaging or surgery if red‑flag symptoms appear or pain persists.​

  • Post‑surgery: visits to check wound healing, neurologic recovery, and activity progression; additional imaging only if symptoms recur or change.​

  • Long‑term: ongoing home exercise, ergonomic advice, weight and bone‑health management, and early reassessment with any new significant leg pain, weakness, or bladder/bowel change.