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.
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Lumbar herniated disc treatments
Conservative approach to herniated disc treatment
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