A herniated disc diagnosis is never good news, but a silver lining lies in the bountiful treatment options available for this common and painful back problem, according to Kaixuan Liu, MD, PhD, founder and president of Atlantic Spine Center.
About 1-3% of adults are affected by herniated discs in the lower spine, which occurs when the spongy material inside seeps through a disc’s tough outer wall and comes into contact with surrounding nerves, causing pain and other nerve symptoms, according to a 2008 study in the journal BMJ Clinical Evidence. About twice as many men suffer from the problem as women, and the highest prevalence is among people ages 30 to 50.
But a bevy of treatments can spell relief from the pain and disability herniated discs can trigger, says Dr. Liu, who is fellowship-trained in minimally invasive spine surgery. “The condition of your spine and the impact your symptoms have on your day-to-day activities are deciding factors in what herniated disc treatment plan best suits you,” he explains. “Treatment options largely depend on how long the patient has dealt with symptoms, along with the severity of pain. Also factors are the patient’s age and if extreme symptoms are present, such as severe numbness or weakness.”
With the overarching goal in herniated disc treatment to stabilize the area, heal damage and ensure the disc doesn’t herniate again, first-line therapies may include NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (brand names Advil or Motrin IB) or naproxen (brand name Aleve) to calm inflammation around the site of the herniated disc.
Other noninvasive treatments include heat or ice; ultrasound; electrical stimulation; short-term bracing of the neck or lower back; prescription pain medications such as codeine or an oxycodone-acetaminophen combination for short periods; nerve pain medications that help relieve nerve-damage pain; muscle relaxants if muscle spasms are present; and cortisone injections directly into the area surrounding spinal nerves, which can relieve swelling and inflammation.
Regardless of the first treatments tried, physical therapy is typically recommended as well, Dr. Liu notes.
“Developing the muscles that support the spine and its components takes pressure off the vertebral disc and allows it to heal,” he explains, “as well as potentially prevent a repeat herniated disc.”
Minimally invasive surgery a strong choice
When a herniated disc is diagnosed as the exact source of your pain, minimally invasive endoscopic surgery can be an optimal choice, Dr. Liu says. About 10% of those with herniated discs still suffer enough lingering pain and disability after 6 weeks of conservative, nonsurgical treatments to consider this option.
“The decision to continue with nonsurgical treatment options or have surgery primarily relies on a patient’s level of pain and dysfunction,” he explains.
Surgical choices include traditional “open” surgery, but minimally invasive endoscopic techniques are increasingly preferred. These endoscopic procedures require only tiny incisions that allow faulty disc material to be removed, relieving pressure on surrounding nerves.
Which minimally invasive surgeries can tackle herniated discs? They include:
- Endoscopic discectomy, which removes damaged disc material causing pain. A modern technique that doesn’t involve bone removal, muscle damage or large skin incisions, this surgery uses x-ray imaging and magnified video to guide an endoscopic probe into the damaged disc space.
- Endoscopic foraminotomy, which can relieve pressure caused by compression from disc herniations as well as other causes. With a quick recovery time, endoscopic foraminotomy patients are typically up and back to normal activities in no time, Dr. Liu says.
Herniated disc surgery is usually an elective procedure, except in rare instances where a patient is experiencing worsening neurological symptoms such as weakness or numbness. For all surgical patients, however, the procedure typically carries a high success rate, Dr. Liu says.
“No matter which type of herniated disc treatment is opted for, the aim is twofold: to relieve pain and enable patients to return to their normal lives,” he adds. “Fortunately, the wide variety of treatment options available for this condition fulfills this ideal for most patients.”
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