Treatment for a lumbar disc herniation will largely depend on the
length of time the patient has had his or her symptoms and the
severity of the pain. For most patients, symptoms from a lumbar disc
herniation will go away over time. While there are no hard and fast
rules, this article reviews some general guidelines for non-surgical
and surgical treatment options.
Generally, patients will start with 6 to 12 weeks of conservative
(meaning non-surgical) treatment, unless their condition is an
emergency situation (e.g., loss of bowel/bladder control or
progressive weakness in the legs). Patients may need to try more
than one type of treatment to discover what works well. Surgery may
be considered if a course of conservative treatment does not provide
pain relief, or if the pain is severe and the patient is having
difficulty functioning.
Conservative (non-surgical) treatments
There are a wide variety of conservative treatment options for
patients to try. The primary goals of treatment are to provide pain
relief and to allow the patient to return to a normal level of
activity. If the symptoms start to abate within the six-week
period, continued conservative treatment is warranted.
Depending on the patient’s clinical situation and physician’s
recommendations, one or several of the following non-surgical
treatments may be considered:
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Physical therapy, exercise and gentle stretching to help
relieve pressure on the nerve root
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Ice and heat therapy for pain relief
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Manipulation (such as by a chiropractor, osteopath, or
appropriately trained physical therapist)
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Non-steroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, naproxen or other pain relief
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Narcotic pain medications for pain relief
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Oral steroids or epidural steroid injections to decrease
inflammation for pain relief
It may be necessary for a patient to try more
than one or a combination of the above treatments. The recommended
length of conservative treatment for patients needs to be
individualized. For those patients who are not in severe pain and
can function well, a longer period of conservative treatment is
reasonable. The vast majorities of people with a lumbar disc
herniation do not need surgery and will recover and return to their
normal lifestyle within several weeks or months of conservative
treatment.
Surgical treatments
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 reasonable option even before six weeks of
symptoms. In recent years, the morbidity (or unwanted side effects,
such as post-operative pain) of surgery for a lumbar herniated disc
has decreased and the results have improved, so surgery is generally
considered a reasonable option for relieving pain and other
neurological symptoms more quickly.
 The
most common surgery to treat a lumbar herniated disc is a
microdiscectomy (microdecompression). This is a minimally-invasive
procedure (since the incision is small and muscles are moved rather
than cut) to remove the herniated portion of the disc under the
nerve root. 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. Depending on the patient’s
clinical situation and surgeon’s preference, a lumbar laminectomy
(open decompression), arthroscopic lumbar discectomy (endoscopic
percutaneous discectomy), or microendoscopic surgery may also be
considered.
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, these conditions are rare.
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