Treatment Options for a Lumbar Herniated Disk

Introduction to Lumbar Herniated Disk Treatment

The care of a patient with a lumbar herniated disk is far from standardized and, to a certain extent, needs to be individualized for each patient. A lumbar herniated disk usually causes leg pain (sciatica or a radiculopathy) and is often referred to as a pinched nerve, bulging disk, ruptured disk, or a slipped disk.

The treatment options for a lumbar herniated disk will largely depend on the length of time the patient has had his or her symptoms and the severity of the back pain. Generally, patients will be advised to start with 6 to 12 weeks of conservative treatment (such as physical therapy).

If conservative treatment for the lumbar herniated disk does not provide pain relief after 6 to 12 weeks it is reasonable to consider surgery. At times, if there is severe pain and the patient is having difficulty maintaining a reasonable level of functioning, surgery may be recommended prior to completing a full 6 weeks of conservative care for the herniated disk.

Most patients will heal a lumbar herniated disk 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 disk, this article outlines some general guidelines for conservative treatment options and surgical treatments.

Conservative Treatments for a Lumbar Herniated Disk

There’s a wide variety of conservative treatment options for patients to try for treatment of a lumbar herniated disk. The primary goals of treatment are to provide relief of pain and to allow return to a normal functional level.

The most common conservative treatment options for a lumbar herniated disk include:

• Rest, followed by slow mobilization
• Pain medications
• Chiropractic/osteopathic manipulations
• Physical therapy
• Epidural steroid injections

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

Surgery for a Lumbar Herniated Disk

If a patient does not feel better after 6 to 12 weeks of conservative care, then surgery may be considered to treat the lumbar herniated disk. 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 good option even before six weeks of symptoms.

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 disk is an elective procedure.

In recent years, the morbidity (such as post-operative pain) of surgery for a lumbar herniated disk has decreased and the results have improved, so surgery is generally considered a very reasonable option to get better quicker.

Surgical treatment options for the lumbar herniated disk include:

• Microdiscectomy (the most common procedure)
• Lumbar laminectomy
• Chymopapain injections
• Arthroscopic lumbar discectomy
• Microendoscopic surgery

A lumbar microdiscectomy (also called a lumbar micro-decompression) is considered the gold standard and is the most common surgery to alleviate pain from a lumbar herniated disk.

• Peter F. Ullrich, Jr, MD

May 8, 2000

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