The mainstay of treatment for herniated disks is an initial period of rest with pain and anti-inflammatory medications, followed by physical therapy. Under this regimen, over 95% of people will recover and return to their normal activities. A small percentage of people do need to go on and have further treatment which may include steroid injections or surgery.
MEDICATIONS
For people with an acute herniated disk caused by some sort of trauma (like a car accident or lifting a very heavy object) and immediately followed by severe pain in the back and leg, narcotic pain relievers and non-steroidal anti-inflammatory medications (NSAIDs) will be prescribed.
If there is also an element of back spasm, anti-spasm drugs, also called muscle relaxants, are usually given. On rare occasions, steroids may be administered either by pill or directly into the blood with an intervenous line (IV).
Long-term pain control is usually limited to NSAIDs, but occasionally narcotics are used as well (if the pain does not respond to NSAIDs).
For people unable to do physical therapy because of pain, steroid injections into the back in the area of the herniation can be very helpful in controlling pain for several months. This allows a vigorous therapy program to be initiated which will usually control pain for the long-term.
LIFESTYE MODIFICATIONS
Any extra weight being carried by an individual, especially weight up front in the abdomen, will worsen any back pain syndrome. A program of diet and exercise is crucial to improving back pain in overweight patients.
Physical therapy is another crucial treatment for nearly everyone with lumbar disk disease. Therapists will instruct you how to properly lift, dress, walk, and perform other activities.
They will also work on strengthening the muscles of the abdomen and lower back to help support the spine. Flexibility of the spine and legs is the third aspect of most therapy programs.
Some practitioners recommend the use of back braces to help support the spine. However, overuse of these devices can weaken the abdominal and back muscles leading to a worsening of the problem. Weight belts can be helpful in preventing injuries in those whose work requires lifting of heavy objects.
A soft cervical collar may be prescribed for people with cervical radiculopathy. The collar helps reduce the pain and muscle spasms by limiting neck movements. A rigid neck collar may occasionally be necessary to eliminate weight bearing on the cervical spine in people with severe pain and muscle spasms.
SURGERY
For the few patients whose symptoms persist despite the above interventions, surgery may be a good option to control pain.
Diskectomy is performed to remove a protruding disk under general anesthesia. The hospital stay is short, about 2-3 days. You will be encouraged to walk the first day after surgery to reduce the risk of blood clots.
Complete recovery takes several weeks. If more than one disk needs to be taken out or if there are other problems in the back besides a herniated disk, more extensive surgery may be needed. This may require a much longer recovery period.
Other surgical options include micro diskectomy, a procedure removing fragments of nucleated disk through a very small incision with X-ray guidance and chemo nucleosis.
Chemonucleolysis involves the injection of an enzyme (called chymopapain) into the herniated disk to dissolve the protruding gelatinous substance. This procedure may be an alternative to diskectomy in certain situations.
