Treatment Options for a Lumbar Herniated Disc

The care of a patient with a lumbar herniated disc is far from standardized and, to a certain extent, needs to be individualized for each patient.

The treatment options for a lumbar herniated disc will largely depend on the length of time the patient has had his or her symptoms and the severity of the back pain. Other considerations include the nature of the symptoms (such as if weakness or numbness is present), and possibly the age of the patient.

Lumbar herniated disc. Click to enlarge

As a general rule, patients will be advised to start with 6 to 12 weeks of nonsurgical treatment, such as physical therapy, epidural injections or medications. There is a wide range of nonsurgical treatments available, and some treatments may work better for some patients than others.

If nonsurgical treatment for the lumbar herniated disc does not provide pain relief after 6 to 12 weeks and the pain is severe, it is reasonable to consider surgery. Surgery may be recommended prior to completing a full 6 weeks of nonsurgical care if:

  • There is severe pain and the patient is having difficulty maintaining a reasonable level of functioning
  • The patient is experiencing progressive neurological symptoms, such as worsening leg weakness and/or numbness.
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For most patients, symptoms from a lumbar herniated disc will resolve on their own, but it may take a prolonged period of time. While there are no hard and fast guidelines for how to heal a herniated disc, this article outlines some general guidelines for deciding on a range of nonsurgical and surgical treatment options.

The primary goals of any type of treatment are twofold:

  1. To provide relief of pain, especially leg pain which can be quite severe and debilitating.
  2. To allow the patient to return to a normal level of everyday activities.

Lumbar Herniated Disc Treatment Considerations

The recommended amount of non-operative treatment for the herniated disc needs to be individualized for each patient. For those patients who are not in severe pain and can function well, a longer period of treatment is reasonable (e.g. 12 weeks). For those patients with severe pain that is not responsive to non-operative treatment, surgery to decompress the nerve is a reasonable option to treat the lumbar herniated disc.

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, both of these conditions are very rare, and most surgery for a lumbar herniated disc is an elective procedure.

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