Herniated Disc Treatment

Options for Relief of Pain From a Lumbar Disc Problem

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Treatment of a herniated disc depends on a number of factors including:

  • Symptoms experienced by the patient
  • Age of the patient
  • Activity level of the patient
  • Presence of worsening symptoms

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:

  • Rest & Activity Modification
    The first treatment is to rest and avoid activities that aggravate your symptoms. Many disc herniations will resolve is given time. In these cases, it is important to avoid activities that aggravate your symptoms.
  • Oral Steroid Medications
    Oral steroid medications can be very helpful in episodes of an acute (sudden) disc herniation. Medications used include Prednisone and Medrol. Like NSAIDs, these powerful anti-inflammatory medications reduce inflammation around the compressed nerves, thereby relieving symptoms.
  • Other Medications
    Other medications often used include narcotic pain medications and muscle relaxers. Narcotic pain medications are useful for severe, short-term pain management. Unfortunately, these medication can make you drowsy and can be 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 idea is to relieve the compression on 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 for Disc Herniations

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 there is a significant nerve compression.

Symptoms on 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.

Sources:

Boden, SD, et al. "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation" J Bone Joint Surg Am. 1990 Mar;72(3):403-8.

Mathews HH and Long BH "Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation" J. Am. Acad. Ortho. Surg., March/April 2002; 10: 80 - 85.

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