Area spine specialists offer innovative, less-invasive herniated disc treatments

This story first appeared in Healthy You - November 2025, The Gazette’s quarterly health publication.

Surgery to repair a herniated disc was once a procedure that evoked images of long hospital stays and a drawn out recovery — but for many patients, surgery is not necessary or has become minimally invasive.

Most often, patients experiencing a disc herniation will not need invasive surgery. As many as 80 percent of people with herniated discs will improve through other treatment routes, such as physical therapy and injections.

“It’s one of the most common things I see people for,” said Dr. Joshua Barber, orthopedic spine surgeon with Physicians’ Clinic of Iowa. “A lot of studies have shown the lifetime prevalence of having a lumbar disc herniation is about 10 to 15 percent, and in general, probably only 5 to 10 percent of those become symptomatic.”

Kyle Pospischil, Corridor regional manager and physical therapist with Rock Valley Physical Therapy, has been helping people with spinal injuries and back pain for 15 years. When a patient comes into his office, the first step is to educate them, Posphischil said.

“We talk about activity modifications that they do throughout the day.” Posphischil said. “The importance of their position or their posture, the body mechanics. We want them to stay active. Motion is medicine.”

Therapy begins with manual treatment techniques, such as joint mobilization, soft-tissue work and guided exercise. These approaches are tailored to the patient, their level of pain and physical capabilities.

Traction therapy is another key component to giving patients pain relief. It is a method of decompressing the spine to relieve pressure on the nerves.

During treatments, Pospischil is evaluating the cause of the pain. Symptoms may present with pain in the extremities or weakness in the legs. As those symptoms are quelled through treatment, the central issue becomes more apparent.

“I warn patients my job is to make you better, however, I might make things feel a little worse at first,” Pospischil said. “Meaning, your leg or arm symptoms might get better, but your back or neck might actually become more sore, which tells me that the symptoms are coming back to the region in which they started from, which is a good thing.”

If patients respond positively to physical therapy, there may not even be a need for imaging. The gold standard remains an MRI, Pospischil said.

If patients are not responding to therapy or pain has not been completely resolved, Pospischil may turn to an epidural steroid injection delivered in unison with imaging.

“If you have a true herniation, it doesn’t always respond to an injection,” he said. “The injection is meant to calm down inflammation and irritation around the area. It can be beneficial. Everybody’s a little different, but it is the next least invasive thing to try before you would consider a surgical intervention.”

Dr. Kyle Larson, orthopedic spine surgeon with Steindler Orthopedic Clinic, consults with a patient at Steindler Orthopedic Clinic’s old location in Iowa City. (Steindler Orthopedic Clinic)

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An operating room at Steindler Orthopedic Clinic in North Liberty is prepared for an operation. (Steindler Orthopedic Clinic)

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For those who require surgery, treatment has become less invasive and recovery times have shortened.

“Many of the options we offer for disc herniations are outpatient procedures where people come in and leave the same day out of our surgery center or a potential stay overnight,” Barber said.

The procedures themselves, as well as pain management, have improved greatly compared to 20 years ago, Barber added. Patients can expect to be without restrictions about six weeks after surgery.

Surgeons like Barber aim to perform the least invasive surgery that provides the greatest benefit. One of the common surgeries that fits the bill is a minimally invasive microdiscectomy.

The procedure involves making a 1-inch incision and inserting a microscope inside a tube to guide the surgeon to the area where the herniated disc is pinching the spinal nerve. A small portion of herniated disc will be removed to relieve the pressure on the nerve.

“In other circumstances, we need to do an open approach, which is a maybe 2- or 3-inch incision and a bigger decompression,” Barber said. “Over time, the options for surgery have broadened when it comes to less invasive surgery.”

Minimally invasive surgeries lessen the risks associated with treating herniated discs.

“There are always going to be risks, but the smaller the incision, the more minimally invasive you can be in general, reduces the risk profile,” said. Dr. Kyle Larson, orthopedic spine surgeon with Steindler Orthopedic Clinic.

Larson and Dr. Benjamin MacLennan at Steindler Orthopedic Clinic offer a less common procedure called a lateral fusion or lateral lumbar fusion to treat hernias. It is a procedure that began to gain traction in the early 2000s. It is a different approach to the spine. Rather than making an incision in the back near the spinal canal, a surgeon will make a small incision to the patient’s flank and approach the herniation from there.

“The advantage of doing those lateral techniques is that you don’t actually have to, in many cases, look into the canal,” Larson said. “You’re able to do everything indirectly. It reduces certain risks relative to the more traditional techniques.”

The options to treat herniated discs continue to expand. No single approach is the best for every patient, Larson said. The growing range of treatments gives providers and patients more paths towards a shared goal: getting back to 100 percent.

“There’s kind of an old adage: you go to 10 different spine surgeons and get 10 different opinions,” Larson said.