Herniated Disc Treatment

Non-surgical and Surgical Treatments for Herniated Discs

 

Most non-medical professionals have heard of herniated discs. They’re common enough that most people have either experienced one (or more) or know someone who has. It’s less often that the non-medical professional understands what’s really going on behind the name, or how the problem is solved. 

Illustration showing herniated disc that needs treatmentLearn how to get relief from your herniated disc.

Also often called slipped discs, or referred to by professionals as HNP (herniated nucleus pulposus), herniated discs happen when the soft inner layer of a disc (the nucleus pulposus) bulges or breaks through the hard outer layer (called the annulus) and puts pressure on the nerve roots that radiate from your spinal cord. 

Herniated Disc Causes and Symptoms

It’s always possible for people to have herniated discs and experience minimal or no pain, so that they never realize it’s happened. But other cases are more intense and cause intense pain, most often in the upper back near the neck or in the lowest part of the back. Other symptoms can include numbness or weakness in the limbs.

The most common causes of herniated discs are fairly straightforward: age and trauma. Discs gradually degenerateover time, so the likelihood of cracks and rips forming in those outer layers of discs simply from age and wear on the spine is high. 

Second most common are traumatic incidents, such as car accidents or falls, as well as stressing a disc during a physical motion like lifting something very heavy improperly. Age can also make a herniated disc more likely in the event of trauma; if people who already have natural degeneration of their discs are making disruptive physical movements, herniated discs can often be a result. 

Radiculopathy and Herniated Discs

Radiculopathy describes a variety of symptoms and conditions all derived from the “pinching of a nerve root in the spinal column,” according to Johns Hopkins Medicine. This can occur at various points on the spine and people may experience symptoms like radiating pain, numbness, and weakness. Sound a bit like herniated disc symptoms? 

Herniated discs need treatment when they compress nerve roots.Herniated discs need treatment when they compress nerve roots.

This isn’t overly surprising or particularly coincidental. Herniated discs are one of the common causes of radiculopathy, among other conditions like bone spurs or stenosis. 

Herniated Disc Treatment

Medications and Injections

When it comes to herniated discs, the almost-universal first treatment step is medication. According to Howard S. An, MD, SpineUniverse editorial board member and Morton International Endowed Chair Professor of Orthopedic Surgery and Director Spine Fellowship Program at Rush University Medical Center in Chicago, doctors “generally [first] recommend anti-inflammatory agents, in addition to non-narcotic analgesics.” Generally one or more medications are prescribed, along with instructions for how to avoid extra strain to the area. 

From there, Dr. An says “steroid injections are the second step. If patients call back in three or four weeks [after taking medication] feeling much better, obviously we don’t do an injection. But not everyone gets better, or they may be somewhat better but still suffering. Then we’d recommend steroid injections, after about four to six weeks of symptoms.” Injections like these are done directly into the area around the spinal nerves and are often guided by ultrasound or X-ray fluoroscopy.

According to Dr. An, about 80-90% of patients get almost entirely better via these methods and after about two months. There may be some lingering back pain, and a need for lifestyle changes to prevent recurrence, but he adds about 50% of patients get better in a month and another 30% feel better after a second month. 

It’s the last 20% or so of patients still suffering with pain that then need to turn to other treatment options, including alternative treatment or surgery. 

Exercise and Physical Therapy

Both exercise and physical therapy can play large roles in recovery from herniated discs and associated pain, but Dr. An cautions that these both must be undertaken carefully and at the proper time. His recommendation is “usually not to push a patient for physical therapy too early and to have the patient do their own exercises.” However, he says good physical therapists will know if it’s too soon for intensive physical therapy. Other modalities like heat, massage, and stretching can be effective early on and help reduce pain.

Dr. An advises that even though patients with herniated discs are in pain and may be inclined toward bed rest, this is a counter-intuitive measure. Measured walking and gentle stretching is beneficial during the healing phase, while complete lack of physical movement can worsen the effects of the herniated disc. 

People walking as herniated disc treatmentGentle exercise like walking can help you feel better if you have a herniated disc.

Alternative Treatments

When it comes to herniated discs specifically, the effects of alternative treatments like chiropractic, acupuncture, and massage are generally more limited, but they can provide some short-term relief and temporary easement of symptoms, and for some people will have more of an effect than others. 

Dr. An says these are things he “would not suggest at the first stage. It’s best not to exact too many treatments at first” However, later on if pain persists or treatments haven’t been successful, these solutions may be recommended as a part of a secondary treatment plan. Overall, it’s best not to recommend them too early though. 

Surgery

In general, the vast majority of people with herniated discs will never need surgery and will recover via medications, injections, and perhaps some physical therapy or alternate treatments. Dr. An says it’s rare that any surgeon would consider operating before about two months of treatment to see if other solutions had worked. 

However, some things are more solid indicators that surgery is necessary, including:

  • Major muscle weakness or numbness during treatment, to the point of not being able to perform normal daily functions
  • Bladder function issues related to the HNP (though this is rare)
  • Pain that affects quality of life and has not improved after other typical treatments including medications and injections

If one or more of these is occurring, patients would then be likely to have their doctor recommend surgical treatment. 

What to Expect from Herniated Disc Surgery

“Conventional surgery for HNP is a microdiscectomy. It’s a minimally invasive, outpatient procedure, which would be the route for about 90% of patients,” says Dr. An. In most cases, this surgery involves removal of the protruding portion of disc. Only rare cases will be more intensive and involve full disc removal. 

After surgery, patients have to avoid exercise for about two to three weeks, and should be almost fully back to normal by about six weeks post-op. Most people feel relief of their symptoms almost instantly after surgery, and an immediate reduction in radicular pain. 

The risks of these procedures are very low, but not nonexistent, as with any surgical procedure, and Dr. An says all patients will be informed of rare risks like infection or nerve damage by their provider ahead of time. However, the biggest thing to be aware of is the possibility of a new herniation. 

Long-Term Changes and Recurrence

After undergoing any treatments, whether medical or surgical, patients feeling better a couple of months after their herniated disc started causing problems may return to their same lifestyle and ignore the possibility of a recurrence of herniated discs. 

This is not particularly rare, occurring in up to 10% of people. Dr. An says, “The reason most people get disc herniations is that the disc itself was not healthy, so you’ve got to change your lifestyle long-term to prevent recurrence.” 

Lifestyle changes and bulging disc treatment at home can mean stop smoking, maintain a healthier weight, or learn exercises to strengthen the core muscles and do them regularly (this is a big one). Core muscle strengthening can strongly reduce the risk of having further disc herniation, because “if you have strong core muscles you share the load with the upper spine and are thus less likely to have recurring HNP,” says Dr. An.

Ultimately, considering the range of treatment options and high rate of successful treatment of herniated discs, the pain and other symptoms may be startling and hard to live with, but it doesn’t have to be something you suffer through. Seeing a doctor about back pain and muscle weakness sooner rather than later can get you started on the right treatment track and feeling normal in a matter of months. 

Updated on: 03/23/21
Continue Reading
Drugs, Medications, and Spinal Injections for Herniated Discs
×
SHOW MAIN MENU
SHOW SUB MENU
Cancel
Delete
Continue Reading:

Drugs, Medications, and Spinal Injections for Herniated Discs

There are many types of medications to help you manage the pain and symptoms often associated with a herniated disc in the neck or low back.
Read More