"Patients who did not receive surgery had an average herniation size that occupied 31.2% of the canal, whereas patients who received surgery had disc herniations that occupied 31.5% of the canal on average.
After controlling for age, race, gender, and location of herniation through a logistic regression, it was found that the size of the herniation and the percentage of the canal that was occupied had no predictive value with regard to failure of conservative management"
Relationship between herniated intervertebral disc fragment weight and pain in lumbar microdiscectomy patients
In 122 patients with lumbar disc herniation (LDH, clinical diagnosis of radiculopathy alongside corresponding MRI evidence of LDH at L3/4, L4/5 or L5/S1) the size of disc fragment, measured on pre operative MRI and the weight of disc fragment, measured intraoperatively, had NO impact on patient reported pain outcomes after lumbar microdiscectomy.
The severity of preoperative symptoms, similarly, were not affected by disc fragment size or weight.
Patients ultimately benefit equally from surgery, irrespective of the size of herniation.
But remember…this also holds true for a non-operative treatment approach. https://journals.sagepub.com/doi/10.1177/2192568219880822
In practice, these findings suggest that the size of disc herniation should not influence the decision-making process in affected patients.