How do they decide if you need surgery for a herniated disc?

Refractory symptoms . Herniated disk surgery should only be considered in the presence of all 3: a)mri evidence of a herniation that is visibly pinching a nerve b)symptoms of a pinched nerve that anatomically corresponds well with MRI evidence c)meds, pt, and epidural injections are first considered. A good predictor of successful surgical outcome is increased nerve pain with nerve tension on exam(straight leg raise).
Symptoms. The severity of symptoms and/or location of the herniation often dictates whether or not surgery will be performed. Discuss the options with your physician.