In Germany, approximately 150,000 surgeries for herniated discs are performed each year. This makes disc surgery one of the most common spinal procedures.
A herniated disc usually develops gradually, with lifestyle factors such as a lack of exercise, being overweight, or weakened back muscles playing a key role. People with sedentary jobs are particularly at risk. The consequences range from back pain to neurological deficits.
In rarer cases, an acute herniation occurs, such as when lifting heavy loads. In these instances, the affected disc immediately causes severe pain, which often requires prompt surgical treatment.
Since many herniated discs result from prolonged strain, patients can specifically prepare for potential disc surgery. Early consultation and choosing a specialized surgeon help alleviate symptoms and preserve spinal mobility in the long term.
People with a herniated disc suffer from severe back pain, which sometimes radiates into the arms and legs @ Microgen /AdobeStock
Before disc surgery is considered, conservative treatment is usually attempted first. Many patients have already been suffering from symptoms, severe back pain, or recurring episodes of disability for some time before a decision is made to proceed with surgery.
Conservative treatments include, among others:
- Physical therapy to strengthen the back muscles
- Massages to relax tense muscles
- Pain management through medication or targeted injections into the affected nerve root
These measures can often provide temporary pain relief but do not always lead to a lasting improvement. Especially after prolonged conservative treatment without sufficient success, surgery is therefore often the only remaining option. If conservative treatment is unsuccessful, surgery is often necessary. During the procedure, the herniated portion of the intervertebral disc is removed to relieve pressure on the compressed nerve roots and provide long-term relief from symptoms.
By Ortenau Klinikum - Ortenau Klinikum, CC BY 3.0, Link
Comprehensive preoperative evaluations are necessary before disc herniation surgery to definitively confirm the herniation and plan the appropriate surgical technique.
The process begins with a detailed medical history interview, followed by a thorough physical examination. During this examination, the doctor checks, among other things, whether neurological deficits such as sensory disturbances or signs of paralysis are already present and which intervertebral disc is affected.
Next, imaging techniques are used to clarify the location and extent of the herniation in the spine. Typical imaging methods include:
The results of these diagnostic tests enable orthopedic surgeons or neurosurgeons to accurately assess the situation. This allows them to locate the affected intervertebral disc and determine the appropriate course of treatment—whether conservative or surgical—on a case-by-case basis.
Intervertebral Disc Surgery at Different Levels
In principle, any intervertebral disc in the spine can be affected. Doctors primarily distinguish between cervical disc herniations in the cervical spine and lumbar disc herniations in the lumbar spine. A herniated disc in the lumbar spine is particularly common and is one of the typical causes of severe lower back pain.
Herniated discs in the thoracic spine are significantly less common, as this region is mechanically more stable due to the ribs. In practice, therefore, the lumbar spine (LWS) and the cervical spine are most commonly affected.
The level of the herniated disc has a major influence on the choice of surgical technique. Depending on the affected region, disc surgery must be individually tailored to relieve pressure on the affected nerve roots as gently as possible and to preserve the mobility of the spine.
In about 9 out of 10 patients, the herniated disc occurs in the lumbar spine @ FGWDesign /AdobeStock
Once it has been determined that surgical treatment of a herniated disc is necessary, the medical team decides on the appropriate surgical technique. Both the location of the herniation and the patient’s individual symptoms play an important role in this decision.
In the past, a herniated disc was often removed through an incision at the front of the body—for example, through a neck incision in the case of a cervical disc herniation. However, this open surgery carries the risk of damaging important ligamentous structures of the spine and leaves visible scars.
Today, significantly more advanced surgical techniques are available. Depending on the findings, microsurgical and endoscopic procedures, minimally invasive methods, or—in specific cases—traditional open surgery may be considered. Highly specialized surgeons can thus perform disc surgery in a particularly gentle manner.
In some situations, the procedure can even be performed under local anesthesia, eliminating the need for general anesthesia. This reduces the burden on patients and, in some cases, allows for a faster recovery.
Minimally invasive disc surgeries are usually more advantageous
Minimally invasive disc surgery has become a standard procedure in recent years. Depending on the location of the herniated disc—whether in the cervical or lumbar spine—different surgical techniques are used.
Among the most common procedures are microsurgical and endoscopic disc surgery. In endoscopic surgery, a special endoscope is used, which, in combination with a surgical microscope or microscope, provides a particularly precise view of the affected tissue. With the aid of a surgical microscope or an endoscope, the surgeon can access the affected area through a small incision in the skin and remove the herniated portion of the disc. Laser-assisted methods are also an option, in which the excess intervertebral disc tissue is selectively destroyed to relieve pressure on the nerve roots.
The advantages of these minimally invasive techniques are clear: smaller incisions, less tissue damage, faster healing, and significantly reduced scarring. In addition, many procedures can be performed without general anesthesia, which reduces the burden on patients.
Since these are complex procedures, minimally invasive and endoscopic procedures should only be performed by experienced surgeons. A specialized, interdisciplinary team and a state-of-the-art operating room are crucial for preventing complications and ensuring a high success rate.
Postoperative care plays a crucial role in the healing process following disc surgery. In the first few weeks after surgery, patients should strictly avoid overexertion and uneven strain on the spine. It is also important to adopt back-friendly habits in daily life and during sexual intercourse after disc surgery.
This is especially important when lifting heavy objects: Avoid bending forward and instead use the strength from your legs. Even just a few wrong movements can put significant strain on the spine again and delay healing.
You should also ensure variety in your daily routine: Change your sitting position regularly, stand up more often, or put your feet up from time to time. This is because the intervertebral disc “thrives” on movement. On the other hand, one-sided strain—such as sitting for long periods while traveling or watching TV in a monotonous manner—should be avoided.
Rest is particularly important during the first 4 to 6 weeks after surgery. After that, the rehabilitation phase typically begins, during which targeted exercises strengthen the muscles, improve mobility, and provide long-term relief from symptoms.
In addition, risk factors such as excess weight should be reduced, as body weight exerts constant pressure on the spine. A balanced exercise regimen not only supports recovery but also helps prevent chronic pain.
If symptoms recur despite all these measures, complementary treatments such as pain management or physical therapy may be necessary to prevent complications. Many patients can soon return to a symptom-free life after successful follow-up care and are usually discharged from the hospital a few days after the procedure.
Sleep Habits After Disc Surgery
Sleep is also an important part of postoperative care following a disc surgery. Be careful not to lie on a mattress that is too soft—it should be firm, especially in the buttocks area, to relieve pressure on the spine. If possible, avoid sleeping on your stomach, as this puts additional pressure on the intervertebral disc. The gentlest positions are on your back or side, which both alleviate discomfort and promote muscle relaxation. This supports healing and helps maintain mobility.
Many procedures are now even performed on an outpatient basis, allowing patients to be discharged home after a brief observation period. Modern, minimally invasive techniques can quickly and significantly relieve pain and restore spinal mobility.
Exercise is an essential part of postoperative care and rehabilitation following disc surgery. However, patients should exercise caution during the first few weeks after surgery: both complete rest and overly strenuous activity can delay the healing process. The goal is to relieve symptoms and gradually regain spinal mobility.
Sports that are gentle on the joints, such as swimming or light cycling, are particularly suitable. Be careful not to stay in cool water for too long, as this can lead to muscle tension. Many indoor pools offer special warm-water days, which provide additional relief for the back and soothing warmth.
On the other hand, avoid sports involving vigorous twisting movements or compressive stress on the spine. In the first 6 months after the procedure, you should refrain from activities such as tennis, squash, boxing, alpine skiing, or jumping sports to prevent complications.
After about 4 to 6 weeks, you can begin a personalized exercise plan supervised by an experienced physical therapist. This will specifically strengthen your back muscles and gently restore your spine’s ability to bear weight. It is important to always consult your treating physician before taking up new sports.
Sex After Disc Surgery
Resuming sexual activity is also part of post-surgery care following a herniated disc operation. Many patients wonder when sexual intercourse is possible again and which positions are gentle on the spine.
As a general rule: Sexual activity should be avoided during the first three weeks after surgery. Starting in the fourth week, gentle movements may be attempted, while more active positions are generally not recommended until six weeks after surgery. It is crucial to avoid any strain that puts pressure on the operated disc.
Gentle, slow movements and back-friendly intimacy are the priority. This helps alleviate discomfort without jeopardizing the healing process. Gentle pelvic movements can even promote mobility and act like light exercise.
Open communication with your partner is also important. Talk about any back pain that may arise and work together to find gentle ways to restore intimacy. In this way, intimacy becomes part of the healing process after disc surgery.
Further Information on Complications and Treatment Options
As with any surgical procedure, complications can occur after disc surgery. These include postoperative bleeding, infections, wound healing disorders, or, in rare cases, neurological deficits. However, thanks to modern surgical techniques and the expertise of specialized orthopedic and surgical specialists, these risks are relatively rare.
In certain situations, instead of removing intervertebral disc tissue, an artificial disc may be implanted or a fusion of the affected vertebrae may be performed. Both procedures are established surgical techniques in spinal surgery and are selected on a case-by-case basis based on the patient’s findings.
The actual procedure is often followed by a phase of rehabilitation. Rehabilitation following disc surgery is crucial for strengthening the back muscles, improving mobility, and providing long-term relief from symptoms. Structured follow-up care and close collaboration within an interdisciplinary team significantly increase the success rate.
In Germany, all procedures are documented according to standardized OPS codes. This ensures transparency, facilitates communication between hospitals, and guarantees that patients receive surgical treatment in accordance with clinical guidelines.
Whether a herniated disc is treated conservatively or surgically always depends on the individual’s specific course of the condition. Studies show that some patients continue to experience symptoms even after prolonged conservative treatment, leading to surgery. During the procedure, surgeons remove the pinched tissue or stabilize the vertebrae. In some cases, the outer ring of the intervertebral disc is even incised to relieve pressure on the nerve roots.
When surgery is necessary for a herniated disc, patients benefit particularly from clinics that specialize in treating herniated discs. An interdisciplinary team specializing in the spine ensures the highest quality of care. The recommendations of the German Society for Orthopedics and Trauma Surgery provide guidance in this regard.
Modern spinal surgery increasingly relies on endoscopic techniques that minimize damage to surrounding tissue and enable faster healing. This allows pain to be quickly and significantly reduced and mobility to be restored.
