If you've got a herniated disc, should you have it removed? Does the location and type of herniation make a difference in how your back feels? These are the two questions studied and discussed in this article.

Patients involved in this study were 18 years old or older and had a disc herniation. Symptoms included low back pain (LBP) and sciatica (pain down the leg). Some patients had other neurologic signs and symptoms such as a positive nerve root tension sign, numbness, or weakness.

Herniations were confirmed by imaging study. They included discs that were protruding, extruding, or sequestered. Protrusion describes a situation where the inner disc material has pushed into (but not past) the outer covering. The amount of disc material is equal across the base of the protrusion.

Extrusion refers to the central disc (nucleus) that has pushed through and past the outer covering. The base of the extrusion is narrower than the amount pushing out. Sometimes this is also called a disc prolapse. If the disc material gets pinched off and separated from the rest of the disc, it's called sequestration.

The patients were divided into two groups. One group received conservative care including physiotherapy, education and counseling, and non-steroidal anti-inflammatory drugs (NSAIDs). A home exercise program was part of the physiotherapy. The second group had a discectomy (surgical removal of the disc).

Results were measured based on the presence of back and leg pain and pain ratings (frequency and severity) for both. Patients were followed for two years. During this study, some of the patients crossed over.

This means that some who were assigned to the conservative care group ended up having surgery. And some who were supposed to have surgery decided to have non-operative care instead. The researchers took this into consideration when analyzing the data.

The results showed that leg pain improved for patients in both treatment groups. This supports findings in other similar studies. Back pain was also better in both groups. But the patients who had a discectomy had better overall (back and leg) pain relief compared with the conservative care group. This was true for everyone no matter what kind of herniation was present. And the improvements were still present at the end of two years.

The findings of this study suggest discectomy is an effective treatment choice for disc herniations of all kinds. Patients benefited equally whether they had disc protrusion, extrusion, or sequestration.

Adam M. Pearson, MD, MS, et al. SPORT Lumbar Intervertebral Disk Herniation and Back Pain. Does Treatment, Location, or Morphology Matter? In Spine. February 15, 2008. Vol. 33. No. 4. Pp. 428-435.