Does surgery heal a herniated disc better?

Short answer

Not better, just faster. Surgery eased leg pain weeks to months sooner, but by 1 year there was little difference from no surgery. When pain had lasted more than 4 months, pain 6 months later was about half with surgery.

Does surgery heal a herniated disc better?
'Herniated disc = surgery' — does this formula hold?
Many people believe that once a disc bulges out and causes leg pain and numbness (sciatica), surgery is the only way out. We checked trials that randomly split people into surgery and no surgery.
Bulging discs shrank on their own
In about 2 out of 3 people
An analysis of 11 studies that re-scanned people treated without surgery found the herniation was reabsorbed in 66.66% of them. The bigger the herniation, the more often it shrank: 96% for broken-off fragments, 70% for discs pushed far out, 13% for mild bulges.
Early surgery meant faster relief
But 1 year later, 95% recovered in both groups
283 people with severe leg pain lasting 6-12 weeks were split into early surgery or waiting without surgery. Leg pain eased faster in the early surgery group. After 1 year, 95% in both groups said they had recovered.
Did the waiting group end up in surgery anyway?
More than half never needed it
Of the 142 people who waited, 55 (39%) had surgery for severe pain after an average of 18.7 weeks. Counting up to 5 years, 46% had surgery. At 5 years, pain and disability scores showed no difference between the groups.
Pooled together, the surgery advantage faded
At 1 year, a 2.3-point gap out of 100
A 2023 analysis of 12 studies with 1,711 people found surgery cut leg pain 12.1 points more on a 100-point scale in the first 6 weeks. The gap shrank to 6.5 points at 3-12 months and 2.3 points at 1 year, close to nothing. Risk of side effects showed no clear difference.
Long-lasting pain was a different story
Pain of 4-12 months dropped far more with surgery
In a study of 128 people whose leg pain had lasted 4-12 months, pain started at 7.7 and 8.0 out of 10. After 6 months it was 2.8 with surgery and 5.2 without. Of the 64 people in the no-surgery group, 22 eventually had surgery.
Bottom line: surgery is the faster path
Not a better one
Leg pain from a herniated disc mostly got better without surgery, and by 1 year there was little difference from surgery. The benefit of surgery was faster relief. When pain had lasted more than 4 months, the benefit of surgery was clear, and when leg weakness (paralysis) appeared, nerves recovered faster with surgery within 3 days.