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Updated: Oct 28, 2025

Full Endoscopic Interlaminar Approach for Paracentral L5-S1 Disc Herniation
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Herniated discs: when is surgery necessary?

Wai Weng Yoon1,2, Jonathan Koch2

  • 1Spinal Surgery Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.

EFORT Open Reviews
|July 16, 2021
PubMed
Summary

This review outlines surgical indications for disc herniations at all spinal levels. It details when surgery is relatively indicated for cervical, thoracic, and lumbar disc herniations based on symptom progression and treatment response.

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Spinal Surgery

Background:

  • Disc herniations can cause significant neurological deficits, necessitating clear surgical guidelines.
  • Absolute surgical indications include progressive myelopathy or cauda equina syndrome.
  • Relative indications for surgery vary by spinal level and require careful consideration.

Purpose of the Study:

  • To review and summarize the relative indications for surgical intervention in cervical, thoracic, and lumbar disc herniations.
  • To differentiate surgical indications based on the specific level of the spine affected.

Main Methods:

  • Systematic review of literature regarding surgical indications for disc herniations.
  • Analysis of indications for cervical disc herniation (CDH), thoracic disc herniation (TDH), and lumbar disc herniation (LDH).
Keywords:
disc herniationevidencesurgical indications

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Main Results:

  • Cervical disc herniation (CDH): Surgery considered after six months of persistent, conservative-treatment-resistant symptoms; high-quality evidence is limited.
  • Thoracic disc herniation (TDH): Surgery indicated for failed conservative treatment or worsening neurological symptoms; preventive surgery may benefit asymptomatic patients with specific MRI findings.
  • Lumbar disc herniation (LDH): Surgery indicated when imaging confirms herniation consistent with clinical findings and conservative care for six weeks fails.

Conclusions:

  • Surgical indications for disc herniations are level-specific and depend on neurological status and treatment response.
  • Further high-quality research, including randomized controlled trials, is needed to refine surgical indications, particularly for CDH.
  • Timely surgical intervention is crucial for deteriorating neurological deficits, while preventive measures are considered for specific TDH cases.