Treatment options for a herniated disc
Individualized treatment for a herniated disc
The primary goal of treatment for each patient is to help relieve pain and
other symptoms resulting from the herniated disc. To achieve this goal, each
patient’s treatment plan should be individualized based on the source
of the pain, the severity of pain and the specific symptoms that the patient
exhibits.
In general, patients usually are advised to start with a course of conservative
care (non-surgical) prior to considering spine surgery for a herniated
disc. Whereas this is true in general, for some patients early surgical
intervention is beneficial. For example, when a patient has progressive
major weakness in the arms or legs due to nerve root pinching from a
herniated disc, having surgery sooner can stop any neurological progression
and create an optimal healing environment for the nerve to recover. In
such cases, without surgical intervention, nerve loss can occur and the
damage may be permanent.
There are also a few relatively rare conditions that require immediate
surgical intervention. For example, cauda equina syndrome, which is usually
marked by progressive weakness in the legs and/or sudden bowel or bladder
dysfunction, requires prompt medical care and surgery.
Conservative and surgical treatments
For lumbar and cervical herniated discs, conservative (non-surgical) treatments
can usually be applied for around four to six weeks to help reduce pain and
discomfort. A process of trial and error is often necessary to find the right
combination of treatments. Patients may try one treatment at a time or may
find it helpful to use a combination of treatment options at once. For example,
treatments focused on pain relief (such as medications) may help patients
better tolerate other treatments (such as manipulation or physical therapy).
In addition to helping with recovery, physical therapy is often used to educate
patients on good body mechanics (such as proper lifting technique) which
helps to prevent excessive wear and tear on the discs.
If conservative treatments are successful in reducing pain and discomfort,
the patient may choose to continue with them. For those patients who
experience severe pain and a high loss of function and don’t find
relief from conservative treatments, surgery may be considered as an
option.
The different conservative and surgical treatment options for a lumbar
herniated disc and a cervical herniated disc are described below.
Lumbar herniated disc treatments
Conservative treatments for a lumbar herniated disc
A combination of the
following conservative treatment
options can be used through at least the first six
weeks of discomfort and pain:
-
Physical therapy, exercise and gentle stretching
to help relieve pressure on the nerve root
-
Ice and heat therapy for pain relief
-
Manipulation (such as chiropractic manipulation)
-
Non-steroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen, naproxen or COX-2 inhibitors for
pain relief
-
Narcotic pain medications for pain relief
-
Oral steroids to decrease inflammation for pain
relief
-
Epidural injections to decrease inflammation for
pain relief
Surgical treatments for a lumbar herniated disc
If a course of conservative treatments (generally
four to six weeks) is not effective for relieving pain from a herniated
disc, lumbar decompression surgery may be considered as an option.
Often a microdiscectomy (or microdecompression) - a type of lumbar
decompression surgery - is used to treat nerve compression from
a herniated disc. During a minimally-invasive microdiscectomy procedure,
the herniated portion of the disc under the nerve root is removed. By
giving the nerve root more space, pressure is relieved and the
nerve root can begin to heal.
The microdiscectomy procedure is usually highly successful for relieving
the leg pain (sciatica) caused by a herniated disc. Although the nerve
root takes several weeks or months to fully heal, patients often feel
immediate relief of their leg pain and usually have a minimal amount
of discomfort following the surgery. For some patients with severe pain
and loss of function, having a microdiscectomy surgery early on will
be the best treatment for their pain.
A more in-depth description of surgery for a lumbar herniated disc can
be found in the article Microdiscectomy
(microdecompression) spine surgery.
Cervical herniated disc treatments
Conservative treatments for a cervical herniated disc
The first step in conservative treatment is usually
rest and the use of non-steroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen, naproxen, or COX-2 inhibitors.
If the pain from a cervical herniated disc is severe and/or continues
for more than a couple of weeks, physicians may prescribe additional
medications including:
If the pain lasts for more than two to four weeks, the following conservative
treatments are often recommended:
-
Physical therapy and exercise to help relieve the
pressure on the nerve root
-
Low-velocity chiropractic manipulation may be helpful;
however, caution should be used with manipulation
if the patient is experiencing any neurological
deficits
-
Manual traction to help open up the cervical foramen
where the nerve root exits the spinal canal
-
Epidural injections to reduce inflammation and
relieve pain
Surgical treatments for a cervical herniated disc
In general, if about six weeks of conservative
treatment fails to relieve the arm pain or if the patient
and the spine specialist determine that surgical removal
of the disc is the best course of treatment, patients
may consider anterior cervical decompression (discectomy).
During this surgical procedure, the disc material is
removed through the front of the neck and then the
disc space is usually fused to keep the disc space
open. Another surgical option to treat a herniated
disc is a posterior cervical laminectomy, where the
disc material is removed through the back of the neck.
For a more detailed explanation, please see Anterior
cervical decompression (discectomy). Cervical decompression can
also be performed through the back of the neck as a posterior cervical
decompression (discectomy). For more information, please read Posterior
cervical decompression (discectomy).
Conclusion to successful treatment of a herniated disc
Treatment of a herniated disc is complicated because of the individualized
nature of each patient’s pain and symptoms. A treatment option that
relieves pain and discomfort for one patient may not work for another. However,
by working with one or several types of spine specialists, patients can find
the best combination of treatment options for their pain and can avoid having
surgery too soon or too late.
By: John P. Revord, MD
January 2005
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