Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Herniated discs are a common spine condition in Singapore, especially among individuals aged 30 to 50. Many cases can be managed with non-surgical treatments such as physiotherapy, medication and lifestyle adjustments. Surgery is typically reserved for more serious cases where symptoms are severe, persistent or accompanied by neurological issues like numbness or weakness.
What Is a Herniated Disc?
A herniated disc, sometimes called a slipped disc, happens when the soft inner part of an intervertebral disc bulges or pushes through a tear in the outer ring. The spine is made of stacked vertebrae separated by discs that act as shock absorbers. When a disc herniates, it can press on nearby nerve roots, producing pain, numbness or weakness.
The discs lose flexibility and hydration with time, which makes them more likely to tear. Common causes of this include:
- Age-related degeneration
- Repetitive bending or twisting
- Heavy lifting
- Sudden strain or injury
- Poor resting posture
Do You Need Surgery for a Herniated Disc?
The decision to undergo herniated disc surgery is based on a combination of factors. Your surgeon will consider the duration and severity of your symptoms, how they impact your daily life, and your overall health. In most cases, conservative treatment is the first line of care. You may not need surgery if:
- Your pain improves within a few weeks to months of starting treatment
- Symptoms are manageable with medication, physiotherapy and lifestyle adjustments
- You maintain normal strength and mobility without major limitations
- Imaging shows no severe nerve compression or structural instability
When symptoms are stable or gradually improving, ongoing non-surgical care and close monitoring can often lead to recovery without the need for surgery. However, the final decision should be made together with a spine specialist, taking into account your specific condition, treatment goals and long-term expectations.
Non-Surgical Treatment Options
Many cases of herniated discs can be managed without surgery. The goal of conservative treatment is to relieve pain, restore function and allow the disc to heal naturally. Most notice improvement within 6 to 12 weeks, although recovery time can vary.
- Short Rest During Acute Flare-Ups: Brief periods of rest can help ease severe pain. However, prolonged bed rest is discouraged as it may weaken muscles and slow overall recovery.
- Medication for Pain Relief: Over-the-counter painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and reduce inflammation.
- Physiotherapy: A physiotherapist can design a personalised exercise programme to improve flexibility, strengthen the core and back muscles, and correct movement patterns that aggravate nerve irritation.
- Cold and Heat Therapy: Applying ice appropriately helps reduce inflammation. Heat therapy can then be introduced to relax muscles, relieve spasms and improve stiffness once initial inflammation subsides.
- Epidural Steroid Injections: For persistent pain, steroid injections near the affected nerve root can provide targeted relief by reducing inflammation and swelling.
With consistent care and proper guidance, many patients achieve lasting improvement and avoid the need for surgical intervention.
When Is Surgery Necessary for a Herniated Disc?
Surgery is usually considered only when conservative treatments fail or when symptoms threaten long-term nerve or spinal function. Seek urgent medical attention if you experience:
- Severe, persistent pain lasting more than 6 to 12 weeks despite appropriate non-surgical care
- Progressive weakness, numbness or tingling, indicating worsening nerve compression
- Loss of bladder or bowel control, a medical emergency linked to cauda equina syndrome that requires immediate surgery
- Inability to perform daily activities due to pain or weakness that affects standing, walking, or working
- Progressive neurological deficits, such as declining muscle strength or reflex changes
If you notice any of these symptoms, please seek medical attention immediately.
Types of Surgery for Herniated Disc
The surgical approach for a herniated disc is tailored to each patient. Factors such as the location of the herniation, degree of nerve compression, presence of spinal instability and severity of symptoms all play a role in determining the best strategy. Previous spinal surgeries and your overall health are also carefully considered. Your surgeon will discuss the most suitable procedure for your situation.
Discectomy (Microdiscectomy)
A discectomy involves removing the part of the disc pressing on a nerve to relieve pain and pressure. A microdiscectomy uses a smaller incision and specialised instruments, often with the aid of a microscope, making it less invasive and allowing for a quicker recovery compared to traditional open surgery.
Many patients experience relief from radicular pain—the pain that radiates down the arms or legs due to nerve compression. However, this procedure is generally less effective for pain confined solely to the back or neck.
Laminectomy
A laminectomy removes part of the lamina, the bony arch of the vertebra, to create more space for the spinal nerves. It is useful when there is bony narrowing of the spinal canal, sometimes performed in combination with a discectomy.
Spinal Fusion
Spinal fusion joins two or more vertebrae to stabilise the spine. It is reserved for cases with instability, severe degeneration or recurrent herniation where stabilisation is necessary. Fusion is a more extensive procedure and usually involves a longer recovery.
Risks and Recovery After Surgery
All surgical procedures carry some level of risk, though this is minimal under the care of an experienced surgeon. For herniated disc surgery, potential complications include infection, bleeding, nerve injury, persistent pain or a recurrence of the herniation. Your surgeon will discuss these risks with you and outline the measures they will take to prevent them.
After the surgery, many patients experience relief from nerve-related pain in their arm or leg. However, the full recovery of strength and function can take several weeks to months, and physiotherapy remains a key part of that process.
To reduce the chance of the herniation recurring, patients are encouraged to:
- Maintain a healthy weight
- Use proper posture and lifting techniques
- Stay active with appropriate exercises
If you suspect you might have a herniated disc and are unsure about the treatment options available, speak with a spine surgeon who will determine the best treatment option for you. Contact Oxford Spine & Neurosurgery Centre today to book an appointment.
Our Spine Specialist in Singapore
Dr Colum Nolan
Senior Consultant Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Dr Colum Nolan is a Senior Consultant Neurosurgeon and the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.
Dr Column held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.
With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.
