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Herniated Disc-Sciatica When Do You Actually Need Surgery · Neck & Back Surgery Answers with Dr. Leonard Kibuule

• 0:00
  SPEAKER_00: Herniated disc and sciatica.
• 0:01
  SPEAKER_00: Do you actually need surgery?
• 0:03
  SPEAKER_00: If you have a herniated disc and sciatica, one of the hardest decisions is knowing how long to keep waiting before surgery because a lot of herniated discs get better without an operation.
• 0:13
  SPEAKER_00: But if you wait too long in the wrong situation and scenario, you can end up with a nerve that's damaged and that may never recover.
• 0:20
  SPEAKER_00: I'm Dr.
• 0:21
  SPEAKER_00: Leonard Kabule.
• 0:22
  SPEAKER_00: I'm an orthopedic spine surgeon here in Houston, Texas.
• 0:24
  SPEAKER_00: And in this video, I'll show you how I decide when it makes sense to wait, when surgery starts becoming the better option, and the signs that can make that decision much more urgent.
• 0:34
  SPEAKER_00: The MRI is only one part of the decision.
• 0:37
  SPEAKER_00: Usually by the time someone gets to me, they've already seen the MRI report.
• 0:41
  SPEAKER_00: A lot of times they're even worried before I even walk into the room.
• 0:44
  SPEAKER_00: They've read words like herniation, degeneration, stenosis, or nerve compression, and now they're wondering how bad this really is and whether surgery is going to be inevitable.
• 0:54
  SPEAKER_00: Their reaction makes sense, but an MRI can show us a lot without telling us the whole story.
• 0:58
  SPEAKER_00: I've seen patients with very large disc herniations who are still functioning remarkably well, and I've seen other patients with much less dramatic imaging who are absolutely miserable because one specific finding matches exactly what that nerve controls.
• 1:12
  SPEAKER_00: So before we talk about surgery, I want to know whether the picture actually matches the patient's presentation.
• 1:18
  SPEAKER_00: Where's the pain going?
• 1:19
  SPEAKER_00: Is there numbness or tingling?
• 1:21
  SPEAKER_00: Are you having trouble walking?
• 1:23
  SPEAKER_00: Can you sleep?
• 1:24
  SPEAKER_00: Has your strength changed?
• 1:25
  SPEAKER_00: And when we examine you, do those findings line up with the nerve that appears to be compressed on the MRI?
• 1:30
  SPEAKER_00: And even when the MRI does line up perfectly with the symptoms, I still don't immediately jump to surgery because the next thing I want to know is what this is actually doing to you.
• 1:40
  SPEAKER_00: And this is where pain can be a little misleading.
• 1:42
  SPEAKER_00: Pain can fool you.
• 1:43
  SPEAKER_00: When you're living with sciatica, it's natural to judge everything by the pain.
• 1:47
  SPEAKER_00: If yesterday your pain was a nine and today it's a six, you feel like you're getting much better.
• 1:52
  SPEAKER_00: And maybe you are.
• 1:53
  SPEAKER_00: But I also want to know exactly what your leg is doing.
• 1:56
  SPEAKER_00: Are you walking better?
• 1:57
  SPEAKER_00: Is the numbness improving?
• 1:58
  SPEAKER_00: Is your strength really holding up?
• 2:00
  SPEAKER_00: Because pain and nerve function don't always improve together.
• 2:03
  SPEAKER_00: I can have one patient whose pain is still severe, but their strength is normal and they're clearly moving in the right direction.
• 2:09
  SPEAKER_00: Then I can have another patient who comes to me and says, Doc, my pain is actually getting better.
• 2:15
  SPEAKER_00: But now their foot is weaker and it's almost been two weeks.
• 2:18
  SPEAKER_00: And that's why pain by itself doesn't tell me whether we need to operate.
• 2:22
  SPEAKER_00: If the pain is severe, but your strength is intact and you're still walking normally and nothing is actually getting worse neurologically, that gives us a little bit of something very valuable.
• 2:31
  SPEAKER_00: Time.
• 2:32
  SPEAKER_00: If you're improving, time may actually be on your side.
• 2:35
  SPEAKER_00: A very common scenario is someone who is active, lifted something heavy, was playing a sport and moved the wrong way, and then suddenly developed pain followed by pain traveling down the leg.
• 2:44
  SPEAKER_00: Not just back pain, but pain down the leg.
• 2:46
  SPEAKER_00: If the MRI shows a relatively fresh discarniation and you're still strong, you're still walking, and things are seemingly easing up and getting better, that may be exactly the kind of situation where I'm comfortable giving your body more time.
• 3:01
  SPEAKER_00: Maybe we use medication to calm things down.
• 3:04
  SPEAKER_00: Maybe physical therapy helps you move a little bit better.
• 3:07
  SPEAKER_00: Maybe an injection gives the nerve enough relief that you can start functioning again.
• 3:11
  SPEAKER_00: The point is not to keep throwing treatments at you forever.
• 3:14
  SPEAKER_00: The point is to see whether your body is actually headed in the right direction.
• 3:18
  SPEAKER_00: Because sciatica can be miserable without necessarily being dangerous.
• 3:23
  SPEAKER_00: If that's what I'm seeing, I'm usually very comfortable letting that natural healing process continue.
• 3:28
  SPEAKER_00: But the moment the nerve starts losing function, the whole decision changes.
• 3:32
  SPEAKER_00: Weakness changes the decision.
• 3:34
  SPEAKER_00: If you come back and now you're stumbling, you can't lift your foot the same way, or your leg is clearly getting weaker.
• 3:41
  SPEAKER_00: That gets my attention very quickly.
• 3:43
  SPEAKER_00: At some point, I'm no longer just asking how uncomfortable you are.
• 3:47
  SPEAKER_00: I'm asking what the pressure is actually doing to the nerve.
• 3:50
  SPEAKER_00: And am I comfortable leaving it there?
• 3:52
  SPEAKER_00: A nerve is living tissue.
• 3:53
  SPEAKER_00: If you keep enough pressure on it for a long enough period of time, eventually it may stop functioning the way that it should.
• 3:59
  SPEAKER_00: And even if we remove that pressure later, there's no guarantee that every bit of strength or sensation is gonna come back.
• 4:06
  SPEAKER_00: That's why weakness can change the decision much faster than just pain alone.
• 4:11
  SPEAKER_00: Which brings us to the question almost everybody asks, how long do you actually give this before surgery starts making more sense?
• 4:18
  SPEAKER_00: So how long should you wait?
• 4:19
  SPEAKER_00: You'll hear four to six weeks mentioned quite a bit with herniated discs, and there's a reason for that.
• 4:24
  SPEAKER_00: A lot of people actually do improve in that window of time, but I never use six weeks as some automatic finish line.
• 4:31
  SPEAKER_00: If you're three or four weeks into this and your strength is good and you're walking better, and you're sleeping a little bit better, and each week is getting noticeably easier than the one before, that may be a great reason for us not to interrupt that progress.
• 4:45
  SPEAKER_00: Now, take someone else who has only been dealing with this for say 10 days, but their foot is noticeably weaker than it was three days ago.
• 4:52
  SPEAKER_00: I'm not gonna tell that person, well, technically you still have another month before we can talk about surgery.
• 4:58
  SPEAKER_00: Oh no, I care less about whether it's been two weeks or six weeks than I do about whether or not your strength is improving or declining.
• 5:07
  SPEAKER_00: I wanna make sure that you're improving.
• 5:09
  SPEAKER_00: That's what's most important.
• 5:10
  SPEAKER_00: There are also a few situations where we don't wait around at all.
• 5:14
  SPEAKER_00: If someone comes to my office and has developed loss of bowel or bladder control, or there is significant nerve compression, that needs urgent medical evaluation.
• 5:23
  SPEAKER_00: Most people aren't in that category.
• 5:25
  SPEAKER_00: They're in a much harder middle ground where the symptoms are serious, but the decision still requires a little bit of judgment.
• 5:32
  SPEAKER_00: And if you're in that gray area right now where you've been told you need surgery, but you're still not sure whether it's actually the right next step.
• 5:40
  SPEAKER_00: My team at Premier Orthopedics and Spine Health can help you sort that out.
• 5:44
  SPEAKER_00: We'll look at the symptoms, we'll examine you, we'll look at the imaging together and talk through what makes sense from there.
• 5:50
  SPEAKER_00: You can find the link to schedule an appointment and make an appointment to come see us for a second opinion in the description below.
• 5:57
  SPEAKER_00: Now, one patient I treated is a good example of what it looks like when waiting stopped making sense.
• 6:03
  SPEAKER_00: She was in her early 60s and she'd been dealing with severe pain down her right leg for about four weeks.
• 6:09
  SPEAKER_00: By the time she came to see me, she had already tried anti-inflammatory medications, muscle relaxers, and even had steroid medications, and she was starting to get back to walking, but the pain was becoming harder to tolerate.
• 6:21
  SPEAKER_00: Now, if she had come to me and told me, hey doc, it still hurts, but I'm walking a little bit better, and the weakness is getting a little bit easier with each week.
• 6:30
  SPEAKER_00: We might have had a very different conversation.
• 6:32
  SPEAKER_00: That wasn't what was happening.
• 6:34
  SPEAKER_00: She was limping.
• 6:35
  SPEAKER_00: The numbness in her foot and toes was getting worse.
• 6:38
  SPEAKER_00: She was developing weakness, she wasn't sleeping normally, and the whole thing was beginning to interfere with her ability to work and to function.
• 6:46
  SPEAKER_00: So now the story, the examination, and the MRI were telling the same story.
• 6:51
  SPEAKER_00: This wasn't a painful disc herniation anymore that we could just wait to have it heal on its own.
• 6:56
  SPEAKER_00: The nerve was starting to lose function.
• 6:58
  SPEAKER_00: At that point, continuing to repeat the same treatment simply because we wanted to avoid surgery just didn't make much sense.
• 7:04
  SPEAKER_00: She underwent a minimally invasive microdyskectomy, and within days, her symptoms began to settle down.
• 7:10
  SPEAKER_00: By her two-week follow-up, the pain was significantly better, and both the sensation and the strength were beginning to come back.
• 7:17
  SPEAKER_00: Now, the lesson there is not that four weeks of sciatica means you need surgery.
• 7:21
  SPEAKER_00: I'll give you another example.
• 7:22
  SPEAKER_00: Another person can have four weeks of sciatica and be nowhere near an operating room.
• 7:27
  SPEAKER_00: The difference is what is happening during those four weeks.
• 7:31
  SPEAKER_00: And once you decide surgery, it may actually be appropriate to think of another decision that matters just as much.
• 7:37
  SPEAKER_00: How much surgery do you really need?
• 7:39
  SPEAKER_00: A herniated disc doesn't automatically mean you need a fusion.
• 7:43
  SPEAKER_00: For straightforward disc herniation pressing on one nerve, the goal may be to simply remove the piece causing pressure with a microdisquectomy.
• 7:49
  SPEAKER_00: I often compare it to a rock in your shoe.
• 7:52
  SPEAKER_00: If the rock is the problem, you take out the rock, you don't replace the entire shoe.
• 7:57
  SPEAKER_00: There are situations where the disc and the surrounding tissue are damaged enough that a bigger operation becomes part of the discussion.
• 8:04
  SPEAKER_00: But that's a separate decision.
• 8:06
  SPEAKER_00: First, we decide whether surgery is needed at all.
• 8:09
  SPEAKER_00: Then we decide how much surgery is actually necessary.
• 8:12
  SPEAKER_00: A quick self-check.
• 8:13
  SPEAKER_00: If you're trying to figure out where you fall in all this, there are a few simple things you can pay attention to at home.
• 8:18
  SPEAKER_00: Can you walk normally on your heels?
• 8:20
  SPEAKER_00: Can you rise up and walk on your toes?
• 8:22
  SPEAKER_00: Can you pull both feet towards you with the same amount of strength?
• 8:26
  SPEAKER_00: Does one leg feel like it's starting to give way?
• 8:29
  SPEAKER_00: Or are you suddenly catching your foot when you walk?
• 8:31
  SPEAKER_00: And don't just ask how you feel today.
• 8:34
  SPEAKER_00: Compare what you can do now with what you could do a few weeks ago.
• 8:37
  SPEAKER_00: If the pain is still there, but you're walking better, your strength feels normal, and you're gradually getting more function back, that's generally a more reassuring pattern.
• 8:46
  SPEAKER_00: If your foot is getting harder to lift, the leg feels weaker, you're stumbling more, or the numbness is spreading, that's something we would want to evaluate rather than waiting to see whether the pain improves on its own.
• 8:57
  SPEAKER_00: This isn't a substitute for neurologic examination, but it can help you recognize when the problem may be starting to affect more than just pain.
• 9:05
  SPEAKER_00: Before you say yes to surgery, if somebody is recommending surgery for herniated discs, you should be able to understand why they're recommending surgery without a medical degree.
• 9:14
  SPEAKER_00: Common discussions between you and your surgeon hopefully will elucidate why it is that they want to operate.
• 9:20
  SPEAKER_00: You should know what they believe is causing your symptoms, why the examination supports the diagnosis, and what is likely to happen if you continue to wait, and what operation will actually fix the intended problem.
• 9:32
  SPEAKER_00: Your MRI looks bad enough, is just not enough.
• 9:35
  SPEAKER_00: A much better explanation is your symptoms and your examination point to this nerve.
• 9:40
  SPEAKER_00: Your MRI shows compression in this same place, and your strength is getting worse because of all of this.
• 9:46
  SPEAKER_00: Now you have a reason for surgery.
• 9:48
  SPEAKER_00: Other times, those pieces don't line up nearly as clearly, and the smartest thing may be to keep watching, change a treatment plan, or gather more information before anybody operates.
• 9:58
  SPEAKER_00: The goal isn't to operate quickly, and it isn't to avoid surgery for as long as humanly possible.
• 10:04
  SPEAKER_00: The goal is to understand what is actually happening and step in when surgery makes more sense than continuing to wait.
• 10:10
  SPEAKER_00: And if the operation being discussed is a microdysquectomy, that usually leads to a whole new set of questions.
• 10:16
  SPEAKER_00: For instance, how quickly are you home?
• 10:19
  SPEAKER_00: When can you return back to work?
• 10:21
  SPEAKER_00: When can you get back to the gym or onto the tennis or basketball court?
• 10:25
  SPEAKER_00: How long does the disc take to actually heal?
• 10:27
  SPEAKER_00: And what does your back actually look like and feel like six months later or a year later?
• 10:32
  SPEAKER_00: That's what I'll walk you through in the next video.
• 10:35
  SPEAKER_00: This is Dr.
• 10:35
  SPEAKER_00: Leonard Kabule signing off.