Treatment options for a herniated disc

Individualized treatment for a herniated disc

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.

Lumbar herniated disc treatments
Conservative treatments for a lumbar herniated disc

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

Surgical treatments for a lumbar herniated disc
If a course of conservative treatments (generally four to six weeks) is not effective for relieving pain from a herniated disc, lumbar decompression surgery may be considered as an option. Often a microdiscectomy (or microdecompression) - a type of lumbar decompression surgery - is used to treat nerve compression from a herniated disc. During a minimally-invasive microdiscectomy procedure, the herniated portion of the disc under the nerve root is removed. By giving the nerve root more space, pressure is relieved and the nerve root can begin to heal. 

The microdiscectomy procedure is usually highly successful for relieving the leg pain (sciatica) caused by a herniated disc. Although the nerve root takes several weeks or months to fully heal, patients often feel immediate relief of their leg pain and usually have a minimal amount of discomfort following the surgery. For some patients with severe pain and loss of function, having a microdiscectomy surgery early on will be the best treatment for their pain.

A more in-depth description of surgery for a lumbar herniated disc can be found in the article Microdiscectomy (microdecompression) spine surgery.

Cervical herniated disc treatments
Conservative treatments for a cervical herniated disc
The first step in conservative treatment is usually rest and the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or COX-2 inhibitors. 

If the pain from a cervical herniated disc is severe and/or continues for more than a couple of weeks, physicians may prescribe additional medications including:

• Oral steroids to decrease inflammation and relieve pain

• Oral narcotic agents for severe pain

If the pain lasts for more than two to four weeks, the following conservative treatments are often recommended:

• Physical therapy and exercise to help relieve the pressure on the nerve root

• Low-velocity chiropractic manipulation may be helpful; however, caution should be used with manipulation if the patient is experiencing any neurological deficits

• Manual traction to help open up the cervical foramen where the nerve root exits the spinal canal

• Epidural injections to reduce inflammation and relieve pain

Surgical treatments for a cervical herniated disc
In general, if about six weeks of conservative treatment fails to relieve the arm pain or if the patient and the spine specialist determine that surgical removal of the disc is the best course of treatment, patients may consider anterior cervical decompression (discectomy). During this surgical procedure, the disc material is removed through the front of the neck and then the disc space is usually fused to keep the disc space open. Another surgical option to treat a herniated disc is a posterior cervical laminectomy, where the disc material is removed through the back of the neck.

For a more detailed explanation, please see Anterior cervical decompression (discectomy). Cervical decompression can also be performed through the back of the neck as a posterior cervical decompression (discectomy). For more information, please read Posterior cervical decompression (discectomy).

Conclusion to successful treatment of a herniated disc

Treatment of a herniated disc is complicated because of the individualized nature of each patient’s pain and symptoms. A treatment option that relieves pain and discomfort for one patient may not work for another. However, by working with one or several types of spine specialists, patients can find the best combination of treatment options for their pain and can avoid having surgery too soon or too late.

By: John P. Revord, MD
January 2005