Should you have lumbar disc surgery?

Should Tiger Woods have had spinal surgery again in September?   See my opinion at the bottom of the article, but if you’re considering surgery yourself, read the whole thing!  I’ve helped many low back pain and sciatica sufferers avoid spinal surgery, but I’ve had a couple of spectacular failures too – in the sense that little I did made much difference, but spinal surgery made an enormous difference to those people.

Once I’ve established that your problem doesn’t affect nerves to the bladder or bowel and that it isn’t likely to be due to a “pathology”, and you’re “just” dealing with pain with or without pins and needles and loss of muscle power in part of the leg, then I can help you work out whether to approach a surgeon or not.

The most important thing to work out initially is whether your pain is due to something for which there may be a “surgical solution”.  I can do that – call me.

Then, you have to decide whether you’re willing to consider surgery – I can help you do that.  There’s no point going to talk to a surgeon unless you’re open to a surgical approach, or one involving injections perhaps (more on that another time).   Many people have based this decision on the severity of their pain at the time.  I humbly suggest that that isn’t a great idea.  Of those who had not had surgery (at the beginning of the study) for disc-related sciatica (Ref 1), the strongest predictor of whether they would end up having surgery proved to be how severe their leg pain was at “baseline” (i.e. when first questionned).

As I’ve said before, the degree of pain that you experience is poorly correlated to “tissue damage”; in fact many people with very severe pain have no evidence of damage at all on MRI.  And yet, 50% of 40 year old men who have no low back pain or sciatica have “disc bulges.  That’s not to deny that if you have a disc bulge or other physical “defect” on an MRI, it may well be the source of your pain, or at least some of it.

I recommend that you have a good non-surgical clinician assess you (surgeons tend to offer to operate on any “defect” that can be seen on an MRI).  If that clinician judges your symptoms likely to be related to something for which there is a surgical approach, then it’s all about likely outcomes (good and bad) with surgery, versus likely outcomes without surgery (good and bad) – long and short term.

Surgery can of course make things worse (I’m not going to give you a list), but so can doing nothing, and so can pretty much all “interventions” (mine included).

Let’s narrow this down to disc problems causing sciatica (to look at all surgeries for all types of lower back problems would take a book!).  Different researchers (2) have repeatedly concluded that there was little difference in outcome between surgical and non-surgical management after 2 years.  However, they also commented that those factors most predictive of poor long-term outcome were fear of movement, other health problems, and longer duration of symptoms.  So, your best chance of a good surgical outcome are:

  • Near certainty that your symptoms are disc-related
  • Maintaining physical activity despite pain
  • Being otherwise fit and healthy
  • Not having suffered the symptoms for long

I suspect Tiger may tick all of those boxes, so it may prove to be a good option for him.  If you’d like to discuss your own problems further, please give me a ring, or drop me an email



1.Verwoerd, A.J.H., Luijsterburg, P. a. J., Lin, C.W.C., Jacobs, W.C.H., Koes, B.W., Verhagen, A.P., 2013. Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. Eur J Pain 17, 1126–1137. doi:10.1002/j.1532-2149.2013.00301.x

2.  Haugen, A.J., Brox, J.I., Grøvle, L., Keller, A., Natvig, B., Soldal, D., Grotle, M., 2012. Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskelet Disord 13, 183. doi:10.1186/1471-2474-13-183
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