Herniated Disc Surgery: When Physical Therapy Fails

You've done the work. You went to physical therapy three times a week. You took the anti-inflammatories. You maybe even tried an epidural injection. But the pain in your leg—the burning, electric sciatica—is still there.

There is a frustrating "limbo" phase in back pain treatment where you feel like you've run out of options but aren't sure if you're "bad enough" for surgery.

At Comprehensive Orthopedic & Spine Care, we specialize in helping patients navigate this exact moment. Dr. Carlos Castro and Dr. Joseph Weinstein don't push surgery as a first resort, but when conservative care fails, we offer the definitive solution: Microdiscectomy.

The "6-Week Rule" and Beyond

Medical guidelines generally suggest 6 weeks of conservative therapy for a herniated disc. Why? Because about 80-90% of herniations will shrink on their own during this window.

But if you are in that remaining 10-20%, waiting longer doesn't help. It just prolongs your suffering.

Signs That PT Has "Failed"

• Plateau: You improved slightly at first, but have been stuck at the same pain level for a month.
• Rebound Pain: You feel better for a few hours after therapy, but the pain roars back the next morning.
• Functional Decline: You are modifying your life—skipping family events, unable to drive—just to manage the pain.
• Neurological Deficit: This is critical. If you have weakness (foot drop) or numbness that is spreading, therapy cannot fix the mechanical compression.

The Solution: Lumbar Microdiscectomy

This is not the "back surgery" of the 1980s with large incisions and week-long hospital stays. It is a precise, targeted decompression.

How It Works

1. Incision: A small 1-inch opening is made over the specific level (e.g., L4-L5).
2. Access: We use a microscope to magnify the nerve root.
3. Removal: We do not remove the whole disc. We only pluck out the fragment that has herniated and is pinching the nerve. The rest of the disc stays to cushion your spine.
4. Relief: The pressure on the nerve is gone instantly.

The "Ah-Ha" Moment

Most patients wake up from anesthesia and realize the leg pain is gone. The nerve pain—that deep, toothache-like throb in the glute or calf—usually resolves immediately.

Recovery: Faster Than You Think

One of the biggest myths is that back surgery requires months of bed rest. In reality, we want you walking immediately.

• Day of Surgery: You walk within hours and go home the same day.
• Week 1: No bending, lifting, or twisting (BLT). You can walk around your house and neighborhood.
• Week 2-4: Most office workers return to their desks.
• Week 6: Physical therapy begins to strengthen the core.
• Month 3: Return to gym, sports, and heavy activity.

Why Waiting Too Long Is Risky

There is a window of opportunity. If a nerve is compressed for too long (months or years), it can suffer permanent damage. Even if we eventually take the pressure off, the nerve might be scarred, leaving you with chronic numbness or weakness.

If you have given conservative care a fair shot and are still in pain, you aren't "giving up." You are making a medical decision to protect your nerve function.

Schedule a Surgical Consultation

If you are tired of living in "treatment limbo," come see Dr. Castro and Dr. Weinstein. We will review your MRI, evaluate your neurological status, and give you an honest assessment of whether it's time to fix the problem at the source.

Stop managing the pain. Start fixing it.