“Do all herniated discs need surgery?”

No, they don't.
Over 80% of people I have seen over the years (as a spine surgeon) have been treated nonoperatively.

No. Not every herniated disc is symptomatic. Physical Therapy intervention can successfully address symptoms related to herniated discs. Surgery is the last line of defense in symptomatic cases that conservative treatment is unsuccessful in addressing.

The simple answer is no, not all herniated discs need surgery. It depends on the degree of herniation, compression on nerves and patient response to more conservative measures such as physiotherapy and injections. Herniated discs that are compressing elements of the spinal cord, and that show possible permanent damage, are often scheduled for surgery. Those that are just causing pain without compression on spinal nerves fall into an area that requires evaluation and expert opinion depending on the situation.

No, not all herniated discs need surgical intervention. Most, indeed, do not. It all depends on the symptoms the herniated disc is causing, as well how long the symptoms have been happening. For example, if it is causing a foot drop, it may be more pressing to intervene surgically. However, if it is causing only pain without neurological symptoms such as weakness or numbness, non-surgical treatments are usually tried initially, and more often than not, successful. These treatments may include short period of rest, braces, oral medications like a Medrol dose pack (short course of steroids), and physical therapy. Less invasive treatments such as injections are often tried if these non-invasive treatments fail, before resorting to surgical intervention.

Ron Noy, MD, FAAOS

No. I treat all of my patients with medication first along with a series of 3 epidural injections given over 3 months in the hope, not the guarantee, that this will relieve their pain. It works 75%-80% of the time.

No, as a matter of fact most can get better without surgery. Conservative measures with NSAIDs, and PT are often successful. Sometimes an epidural steroid injection can help. Surgery is indicated for weakness, an extruded disc fragment or failure of conservative treatments.

No. Herniated discs come in a variety of shapes and sizes. Depending on the morphology, a disc may go back into place or resort over time. Physical therapy and especially McKenzie type exercises can help this process and avoid surgery. An extruded disc is analogous to the jelly squirting out of a jelly doughnut. This type may resorb and shrink over time eliminating the need for surgery.