Lumbar Herniated Disc Treatment Options

Medications

• • Pain Relievers: Over-the-counter pain medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.
  • Muscle Relaxants: These may be prescribed to relieve muscle spasms often associated with lumbar disc herniation.
  • Nerve Pain Medications: Drugs such as gabapentin or pregabalin can be used to manage nerve pain.
  • Corticosteroids: Oral or injectable steroids may reduce inflammation and relieve acute pain. Epidural steroid injections deliver the medication directly to the site of nerve compression. Epidurals reduce inflammation and provide short-term pain relief.

Physical Therapy

Physical therapy plays a crucial role in the recovery process. Working with Dr. Cyriac, a physical therapist designs a personalized exercise program focusing on strengthening the muscles around the spine, improving flexibility, and promoting proper posture. Techniques may include pelvic traction, gentle massage, stretching, strengthening exercises, and modalities such as heat or cold therapy, ultrasound, and electrical stimulation.

Activity Modification and Rest

Initially, short periods of rest and activity modification are recommended to alleviate acute pain. However, prolonged bed rest is generally discouraged as it can lead to muscle weakness and joint stiffness. Patients are advised to avoid activities that exacerbate symptoms, such as heavy lifting or prolonged sitting.

Manual Therapy

Manual therapy techniques, including spinal manipulation or mobilization performed by a trained chiropractor or physical therapist, can help relieve pain and improve spinal function. However, these should be performed cautiously, particularly in severe or acute herniation patients.

Lifestyle Modifications

Patients are encouraged to adopt a healthy lifestyle, including regular exercise, maintaining a healthy weight, and practicing proper body mechanics during daily activities to prevent further stress on the spine.

1. Epidural Steroid Injections – In cases where conservative measures do not provide sufficient relief, an epidural steroid injection may be administered. This involves injecting a corticosteroid directly into the epidural space around the affected nerve root to reduce inflammation and alleviate pain.
2. Nerve Blocks – Nerve blocks can be used for diagnostic purposes and temporary pain relief. These injections target specific nerves to block pain signals.

Surgery is considered when conservative treatments fail to provide relief after several weeks to months or if the patient experiences significant neurological deficits such as severe weakness or loss of bowel or bladder control.

Microdiscectomy

This is the most common surgical procedure for lumbar disc herniation. It involves using a microscope and removing the disc portion, compressing the nerve root, often using minimally invasive techniques. Microdiscectomy typically results in quick relief of leg pain (sciatica).

Endoscopic discectomy

An endoscopic discectomy is a minimally invasive surgical procedure used to treat herniated discs in the spine. The procedure involves the use of an endoscope—a small, flexible tube with a camera and light at the end—which allows the surgeon to visualize and remove the herniated portion of the intervertebral disc pressing on spinal nerves and causing pain or neurological symptoms. Endoscopic discectomy is even less invasive than microdiscectomy.

Disc Replacement

Disc replacement surgery involves replacing the damaged disc with an artificial one. This procedure aims to maintain spinal mobility and is usually considered for younger patients with isolated disc disease.

Spinal Fusion

In cases of recurrent herniation or significant spinal instability, spinal fusion may be recommended. This procedure fuses two or more vertebrae to stabilize the spine but limits mobility in the fused segment.

Conservative treatments can be effective for many patients, with symptoms improving over weeks to months. Patients who try conservative measures for too long before choosing surgery. risk that they may not experience the same improvements with surgery because of long-term nerve damage. Minimally invasive spine surgeon Dr. Mathew Cyriac will discuss this with you and recommend the length of time you should try nonsurgical measures before considering surgery.

Surgical interventions typically offer quicker pain relief, especially for sciatica, but involve a recovery period that may include physical therapy and activity modification. Long-term outcomes are generally favorable, especially with appropriate treatment and lifestyle modifications to prevent recurrence.