Herniated (Slipped) Disc Treatment in Dubai
Who you'll see
Dr Sherief Elsayed
Consultant Spinal Surgeon, FRCS (Tr & Orth), UK-trained
Medically reviewed by Dr Sherief Elsayed, UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth). Last reviewed 15 October 2026.
A herniated disc, also called a slipped disc or disc prolapse, is a common cause of sciatica, and of arm pain when it happens in the neck. This page explains what your MRI report means, how often a herniation settles by itself, and when an operation such as a microdiscectomy or an endoscopic discectomy is worth considering. Dr Sherief Elsayed treats disc herniations with injections and with surgery.
At a glance
- Disc bulges and protrusions are common on the MRI scans of people with no pain, so a scan finding matters only if it matches your symptoms and examination (Brinjikji et al., 2015).
- Many herniations shrink without an operation. Extrusions and broken-off fragments, where disc material has pushed further out, are the most likely to shrink (Chiu et al., 2015).
- Surgery relieves leg pain faster than continued non-surgical care, but on average the results are similar by 1 to 2 years (Peul et al., 2007; Peul et al., 2008).
- New numbness between the legs, or new bladder or bowel problems, need emergency care: call 998.
What is a herniated disc?
The discs between the bones of the spine (the vertebrae) act as shock absorbers. Each has a tough outer ring, the annulus, and a soft, jelly-like centre, the nucleus. In a herniation, part of the centre pushes out through a weak point or tear in the ring. If it presses on or inflames a nerve root, it causes pain, tingling, numbness or weakness along that nerve: down the leg (sciatica) from the lower back, or down the arm from the neck. Despite the everyday name, the disc does not slip out of place.
Herniations are linked with age-related wear of the disc, sometimes with no clear trigger. This page focuses on the lower back (the lumbar spine), with a short section on the neck below.
Bulge, protrusion, extrusion, sequestration: what your MRI report means
- Bulge: the disc extends slightly beyond its normal edge, evenly around a wide part of its rim. This is usually an ageing change rather than a true herniation.
- Protrusion: a localised herniation in which the part that sticks out is narrower than its base, where it joins the disc.
- Extrusion: the escaped material is wider than the neck that connects it to the disc, like a mushroom on a stalk.
- Sequestration: a fragment has broken off completely and can move up or down the spinal canal.
These words describe shape, not how much pain to expect. A review of 33 studies, covering 3,110 people without back pain, found disc bulges in 30% of 20-year-olds, rising to 84% of 80-year-olds, and protrusions in 29% of 20-year-olds, rising to 43% of 80-year-olds (Brinjikji et al., 2015). If you have been told you have a bulging disc, read when a disc bulge becomes a problem.
Symptoms of a lumbar disc herniation
- Leg pain, often worse than the back pain, typically spreading below the knee along the path of one nerve.
- Pins and needles or numbness in part of the leg or foot.
- Weakness, such as difficulty lifting the foot (foot drop) or standing on tiptoe.
- Pain that is worse with sitting, bending, coughing or sneezing.
- Back pain, which may be mild or absent.
How a herniated disc is diagnosed
- History and examination. The pattern of pain, numbness and weakness usually points to one nerve. In the straight leg raise test, the doctor lifts your straightened leg while you lie on your back; reproducing your leg pain suggests an irritated nerve. Strength, reflexes and sensation are also checked.
- MRI scan. This shows the discs and nerves in detail. NICE advises against routine imaging outside specialist care, and in specialist care only if the result is likely to change treatment (NICE NG59, recommendations 1.1.4 and 1.1.6), so an MRI is usually arranged when an injection or surgery is being considered.
- Other tests. X-rays do not show discs. A CT scan is used if you cannot have an MRI, and nerve conduction studies occasionally help when the source of symptoms is unclear.
Will a herniated disc get better on its own?
Often, yes. A systematic review of people treated without surgery who had repeat scans found that, in pooled data from nine studies, the herniation shrank in 96% of sequestrations, 70% of extrusions, 41% of protrusions and 13% of bulges, and disappeared completely in 43% of sequestrations and 15% of extrusions (Chiu et al., 2015). A large herniation on the scan is not, by itself, a reason for surgery.
Symptoms often improve too. In a Dutch trial of 283 people who had already had 6 to 12 weeks of severe sciatica, 39% of those who began with prolonged non-surgical care had an operation within the first year (Peul et al., 2007), and 44% by 2 years (Peul et al., 2008). The others did not need one.
Treatment without surgery
Non-surgical treatment comes first unless there is severe or worsening weakness, or signs of cauda equina syndrome (see urgent symptoms below). The full step-by-step approach is on the sciatica treatment in Dubai page. In brief:
- Stay active. NICE advises information and support to help you continue normal activities (NICE NG59, recommendation 1.2.1).
- Exercise and physiotherapy. NICE supports exercise programmes, with manual therapy (manipulation, mobilisation or massage) only as part of a package that includes exercise (NICE NG59, recommendations 1.2.2 and 1.2.7).
- Medicines. NICE advises against gabapentin, pregabalin, steroid tablets and benzodiazepines for sciatica (no overall evidence of benefit, and evidence of harm), and against opioids for long-standing sciatica. Anti-inflammatories, if used, should be at the lowest dose for the shortest time (NICE NG59, recommendations 1.2.16, 1.2.17 and 1.2.21).
- Injections. NICE advises considering an epidural of local anaesthetic and steroid for acute and severe sciatica (NICE NG59, recommendation 1.3.5). It can ease pain while the disc settles, but does not remove the disc. Dr Elsayed performs epidurals and nerve root blocks; see epidural steroid injections in Dubai.
When is surgery considered?
NICE advises considering surgery to free the nerve when non-surgical treatment has not improved pain or function and the scan findings match the symptoms (NICE NG59, recommendation 1.3.8). Your weight, smoking or psychological distress should not decide whether you are referred for a surgical opinion (NICE NG59, recommendation 1.3.7).
Surgery is most likely to help if:
- disabling leg pain has persisted despite non-surgical care (the main trials included people after at least 6 weeks of symptoms);
- the leg pain, examination and MRI all point to the same nerve;
- you have weakness that is significant or getting worse;
- you have cauda equina syndrome, which needs emergency surgery.
Surgery is less likely to help if your main problem is back pain without leg pain, if the disc on the scan does not match your symptoms, or if you are steadily improving.
The operations: microdiscectomy and endoscopic discectomy
Both operations remove only the herniated fragment pressing on the nerve, not the whole disc, and neither fuses the spine. Both are done under anaesthetic, lying face down, with X-ray to confirm the correct level. Dr Elsayed performs microdiscectomy and endoscopic discectomy (transforaminal and interlaminar) at American Hospital Dubai (Oud Metha and Dubai Science Park) and Emirates Hospital Jumeirah.
Microdiscectomy. Through a small cut in the middle of the lower back, the muscles are moved aside and a small window is made in the bone and ligament at the back of the spine. Using a microscope, the surgeon gently moves the nerve aside and removes the herniated fragment and any loose pieces inside the disc.
Endoscopic discectomy. A thin tube carrying a camera and fine instruments is passed through a smaller cut, either from the side through the opening where the nerve leaves the spine (transforaminal), or from the back between two vertebrae (interlaminar). Whether an endoscopic approach suits you depends on where the herniation sits, the level and any previous surgery. The type of anaesthetic is discussed at your consultation.
| Microdiscectomy | Full-endoscopic discectomy | |
|---|---|---|
| How the disc is reached | Small midline cut, microscope | Thin camera tube, smaller cut |
| Leg pain relief | Similar in trials | Similar in trials (Patel et al., 2026) |
| Wound infection, healing problems, haematoma | More often | Less often (Patel et al., 2026) |
| Return to work | Later | About 23 days sooner on average (Patel et al., 2026) |
| X-ray exposure | Lower | Higher (Patel et al., 2026) |
| Leftover fragment or repeat surgery | Less often | More often in non-randomised studies (Yang et al., 2022) |
What happens on the day
- Before: you will be told when to stop eating and drinking, and how to manage blood thinners or diabetes medicines. Never stop a blood thinner without agreement from the doctor who prescribes it. The risks and alternatives are explained again and you sign a consent form.
- Afterwards: staff check your leg strength, sensation and pain relief, and you are helped to walk. Most people stay one night in hospital.
Recovery, work and driving
- Symptoms: leg pain often eases quickly. Numbness and weakness can take weeks or months to recover, and sometimes do not recover fully.
- Activity: walking is encouraged from the start; your plan for sitting, lifting and sport is agreed before you go home.
- Physiotherapy: a Cochrane review of 22 trials (2,503 people) found that exercise programmes starting 4 to 6 weeks after surgery reduced pain and disability faster than no treatment, though the evidence was of low quality, and no trial reported more repeat operations with exercise (Oosterhuis et al., 2014).
- Work: a 2025 review found that, on average, 78% of people returned to work after microdiscectomy, and the average time back was just under 5 weeks (Saltychev et al., 2025). Desk work is usually possible sooner than heavy manual work. Your own timing is agreed at your consultation.
- Driving: wait until you can sit comfortably, turn to look behind you and brake hard in an emergency, and are not taking medicines that cause drowsiness. Check your motor insurance terms.
- Wound and follow-up: wound care and your follow-up appointment are explained before you go home.
Risks of discectomy
A review of 42 prospective studies found that 12.5% of patients had some kind of complication after open microdiscectomy (Shriver et al., 2015). These figures come from published studies, not from any one surgeon’s results.
Common or short-lived
- Wound soreness and some back ache for the first few weeks.
- Temporary tingling, burning or numbness in the leg, more common after full-endoscopic than open surgery in non-randomised studies (Yang et al., 2022).
Uncommon
- Recurrent disc herniation: 4.4% in one review (Shriver et al., 2015); 5.1% after microdiscectomy and 3.5% after full-endoscopic discectomy in another, a review Dr Elsayed co-authored (Bombieri et al., 2022).
- Repeat surgery: 7.1% after open microdiscectomy (Shriver et al., 2015). In a large US study, 15% had a further operation within 8 years, 62% of them for a recurrent herniation (Leven et al., 2015). See preventing a disc herniation from coming back.
- A tear in the dura, the membrane around the nerves, which can leak spinal fluid: 3.1% of 799 first-time open discectomies. It lengthened the operation and hospital stay but did not affect pain or function over up to 4 years (Desai et al., 2011).
- Wound problems such as infection, breakdown or a fluid collection: 2.1% (Shriver et al., 2015).
Rare but serious
- Nerve injury: direct nerve root injury in 0.3% (Bombieri et al., 2022) to 2.6% (Shriver et al., 2015) of microdiscectomies, and new or worse weakness or numbness in 1.3% (Shriver et al., 2015).
- Bleeding that presses on the nerves (a haematoma): 0.5%, which may need an urgent operation (Shriver et al., 2015).
- Infection in the disc space (discitis), blood clots in the legs or lungs, and complications of the anaesthetic.
- Very rarely, injury to the large blood vessels or bowel in front of the spine.
What to expect: the evidence in plain terms
- Faster relief. In the Dutch trial, people given early surgery (on average about 2 weeks after joining the trial) had faster relief of leg pain and recovered faster than those given prolonged non-surgical care. After 1 year, 95% in both groups felt they had recovered (Peul et al., 2007).
- Similar results later, on average. Outcomes were similar by 1 year and did not change in the second year. At 2 years, 20% of all patients, whichever treatment they had, were not satisfied with their outcome (Peul et al., 2008).
- Long term. In the US SPORT study, people who had surgery improved more on average than those who did not, and results in both groups changed little between 4 and 8 years. Many patients switched groups, so this comparison is less reliable than a purely randomised one (Lurie et al., 2014).
- Endoscopic or microscopic? In a Dutch trial of 613 people, transforaminal endoscopic discectomy was no worse than open microdiscectomy for leg pain at 12 months; it was slightly better on several measures, but the differences were small and may not matter in practice (Gadjradj et al., 2022). A 2026 analysis of 17 trials (2,238 patients) found similar leg pain with both, with the trade-offs shown in the table above (Patel et al., 2026).
- The decision. Unless there is worsening weakness or cauda equina syndrome, the choice is mostly about how quickly you need relief, weighed against the risks of surgery and the chance of recovering without it.
Alternatives, and other operations
You can continue non-surgical care, or try an injection, while the pain is manageable and your strength is not getting worse. Fusion and disc replacement are not standard operations for a simple disc herniation; they are used for other problems, such as instability or a severely worn disc, and are discussed separately if relevant.
Neck (cervical) disc herniation
A disc herniation in the neck can press on a nerve root, causing pain, tingling, numbness or weakness in the arm and hand, called cervical radiculopathy. If it presses on the spinal cord, it can cause clumsy hands, difficulty with buttons and unsteady walking, which need prompt specialist assessment. Treatment usually starts without surgery. When surgery is needed, the disc is usually removed from the front of the neck, and the space is either fused or fitted with an artificial disc; the two are compared in ACDF or cervical disc replacement?
Symptoms that need urgent care
Call 998 (UAE ambulance) or go to the nearest emergency department straight away if you develop:
- numbness between the legs, or around the genitals or back passage;
- new difficulty passing urine, loss of bladder or bowel control, or new loss of sexual function;
- sciatica in both legs, or leg weakness that is getting worse.
These can be signs of cauda equina syndrome, in which a large herniation compresses the bundle of nerves at the bottom of the spinal canal. After surgery, also seek urgent advice for fever, redness or discharge from the wound, worsening leg pain or weakness, a severe headache when upright, or calf swelling or breathlessness.
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Your consultation with Dr Sherief Elsayed
Dr Sherief Elsayed is a UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth). He assesses and treats disc herniations in the lower back and neck: he performs epidurals and nerve root blocks, and his surgical work includes minimally invasive and endoscopic spinal surgery, as well as revision surgery. He will examine you, review your MRI or arrange one, check whether the scan matches your symptoms, and explain whether waiting, an injection or an operation suits you at that point.
He sees patients at OrthoPro Clinic, Dubai Science Park, and at UPANDRUNNING on Al Wasl Road. Injections are performed at American Hospital Dubai, and he operates at American Hospital Dubai (Oud Metha and Dubai Science Park) and Emirates Hospital Jumeirah. To book, call OrthoPro Clinic on 04 835 9000, send a WhatsApp message to 052 105 2798, or use the contact page. Fees depend on the procedure and your insurance. Most major insurance accepted. Please check with reception.
Frequently asked questions
A bulge is a slight, even spread of the disc beyond its normal edge and is very common with age, even in people with no pain. A herniation is a more localised escape of disc material that is more likely to press on a nerve. What matters is whether the scan matches your symptoms.
Often, yes. Many herniations shrink on repeat scans, especially extrusions and broken-off fragments, and many people with sciatica recover without an operation.
You can start with your GP or a physiotherapist. See a spinal specialist if leg or arm pain is severe or not improving after about 6 weeks, or if you have weakness. Go to an emergency department straight away for the urgent symptoms above.
Surgery is considered when disabling leg pain that matches the MRI has not improved with non-surgical treatment, or sooner if weakness is getting worse. Cauda equina syndrome needs emergency surgery.
Trials show similar leg pain relief. Endoscopic surgery has meant fewer wound problems and a quicker return to work on average, but more X-ray exposure and, in some studies, more repeat operations.
Leg pain often eases quickly. In a 2025 review, people returned to work after just under 5 weeks on average; numbness or weakness can take longer to recover.
Yes. Recurrent herniation occurs in roughly 4 to 5 in 100 patients in published reviews, and some people need a further operation.
Yes. Exercise-based physiotherapy is the mainstay of non-surgical care, and manipulation or massage can be added alongside exercise rather than instead of it.