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 Treatment for a lumbar disc
herniation will largely depend on the length of time the patient has had
his or her symptoms and the severity of the pain. For most patients,
symptoms from a lumbar disc herniation will go away over time. While there
are no hard and fast rules, this article reviews some general guidelines
for non-surgical and surgical treatment options.
Generally, patients will start with 6 to 12 weeks of conservative
(meaning non-surgical) treatment, unless their condition is an emergency
situation (e.g., loss of bowel/bladder control or progressive weakness in
the legs). Patients may need to try more than one type of treatment to
discover what works well. Surgery may be considered if a course of
conservative treatment does not provide pain relief, or if the pain is
severe and the patient is having difficulty functioning.
Conservative (non-surgical) treatments
There are a wide variety of conservative treatment options for patients
to try. The primary goals of treatment are to provide pain relief and to
allow the patient to return to a normal level of activity. If the
symptoms start to abate within the six-week period, continued conservative
treatment is warranted. Depending on the patient’s clinical
situation and physician’s recommendations, one or several of the
following non-surgical treatments may be considered:
·
Physical therapy, exercise and gentle
stretching to help relieve pressure on the nerve root
·
Ice and heat therapy for pain relief
·
Manipulation (such as by a chiropractor,
osteopath, or appropriately trained physical therapist)
·
Non-steroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen, naproxen or other pain relief
·
Narcotic pain medications for pain relief
·
Oral steroids or epidural steroid injections
to decrease inflammation for pain relief
It may be necessary for a patient to try more than one or a combination
of the above treatments. The recommended length of conservative treatment
for patients needs to be individualized. For those patients who are not in
severe pain and can function well, a longer period of conservative
treatment is reasonable. The vast majorities of people with a lumbar disc
herniation do not need surgery and will recover and return to their normal
lifestyle within several weeks or months of conservative treatment.
Surgical treatments
The goal of surgery is to help alleviate the pain faster. If a patient
has severe pain and is unable to function at a satisfactory level, surgery
may be a reasonable option even before six weeks of symptoms. In recent
years, the morbidity (or unwanted side effects, such as post-operative
pain) of surgery for a lumbar herniated disc has decreased and the results
have improved, so surgery is generally considered a reasonable option for
relieving pain and other neurological symptoms more quickly.
 The most common surgery
to treat a lumbar herniated disc is a microdiscectomy (microdecompression).
This is a minimally-invasive procedure (since the incision is small and
muscles are moved rather than cut) to remove the herniated portion of the
disc under the nerve root. 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. Depending on the patient’s clinical situation and
surgeon’s preference, a lumbar laminectomy (open decompression),
arthroscopic lumbar discectomy (endoscopic percutaneous discectomy), or
microendoscopic surgery may also be considered.
Any patient who has progressive neurological deficits or develops the
sudden onset of bowel or bladder dysfunction should have an immediate
surgical evaluation, as these conditions may represent a surgical
emergency. Fortunately, these conditions are rare.
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