Lumbar Spine Herniated Disc Treatment Options

Treatment of a herniated disc depends on a number of factors including: when the disc herniation occurred, symptoms experienced by the patient, the age of the patient, activity level, and the presence of worsening symptoms.

Treatment Options

Most often, treatments of a herniated disc begin conservatively and become more aggressive if the symptoms persist. After diagnosing a herniated disc, treatment usually begins with the following.

Rest and Activity Modification

The first treatment is to rest and avoid activities that aggravate your symptoms. The vast majority of disc herniations will resolve if given time. In these cases, it is important to avoid activities that aggravate your symptoms.

Ice and Heat Applications

Ice and heat application can be extremely helpful in relieving the painful symptoms of a disc herniation. By helping to relax the muscles of the back, ice and heat applications can relieve muscle spasm and provide significant pain relief.

Physical Therapy

Physical therapy and lumbar stabilization exercises do not directly alter the herniated disc, but they can stabilize the lumbar spine muscles. This has an effect of decreasing the load experienced by the disc and vertebrae. Stronger, well-balanced muscles help control the lumbar spine and minimize the risk or injury to the nerves and the disc.

Anti-Inflammatory Medications

Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, and often help relieve the pain associated with a disc herniation. By reducing inflammation, these medications can relieve some pressure on the compressed nerves. NSAIDs should be used under your healthcare provider's supervision.

Oral Steroid Medications

Oral steroid medications have been used to treat episodes of an acute (sudden) disc herniation. Medications used include Prednisone and Medrol (methylprednisolone). It is not clear however, how effective they are on pain.

Other Medications

Other medications often used include narcotic pain medications and muscle relaxers. Narcotic pain medications are useful for severe, short-term pain management. It's important to know that these medicines can make you drowsy and are addictive. It is important to use these for only brief periods of time. Muscle relaxers are used to treat spasm of spinal muscles often seen with disc herniations. Often the muscle spasm is worse than the pain from the disc pressing on the nerves.

Epidural Steroid Injections

Injections of cortisone can be administered directly in the area of nerve compression. Like oral anti-inflammatory medications, the goal is to relieve the irritation of the nerves. When the injection is used, the medication is delivered to the area of the disc herniation, rather than being taken orally and traveling throughout your body.

Surgery

Treatment of a disc herniation usually begins with the simple steps listed above. However, surgical treatment of a herniated disc may be recommended soon after the injury if several weeks of non-operative treatment doesn't provide adequate relief. It's important to realize that the size of the disc herniation and the amount of nerve compression doesn't dictate whether you will need surgery. Studies have shown that even massive disc herniations can be successfully treated without surgery.

Symptoms of pain and sensory abnormalities usually do not require immediate intervention, but patients who have significant weakness, any evidence of cauda equina syndrome, or a rapidly progressing problem may require more prompt surgical treatment.

Most often surgery is recommended if more conservative measures do not relieve your symptoms. Surgery is performed to remove the herniated disc and free up space around the compressed nerve. Depending on the size and location of the herniated disc, and associated problems (such as spinal stenosis, spinal arthritis, etc.), the surgery can be done by several techniques. In very straightforward cases, endoscopic or microscopic excision of the herniated disc may be possible. However, this is not always recommended, and in some cases, a more significant surgery may need to be performed.