Herniated Disc: Treatment and Recovery

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Treatment
There are several conservative treatment options that may relieve the symptoms associated with a herniated disc. These include: alternate bed rest with ambulation and medications to reduce inflammation and pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used for this purpose.

Physical therapy may be incorporated into the patient's treatment plan. This might include exercise, massage, thermotherapy, as well as a device designed to support the back - a corset, back belt, or brace.

Remember that most patients with a herniated disc will get better without surgery.

Surgery
When no improvement is noted after a course of conservative treatment, surgery might be considered. However, remember that most patients with a herniated disc will get better without surgery.

A Discectomy is the surgical removal of part or the entire offending intervertebral disc. Microdiscectomy incorporates the use of a microscope to magnify the surgical field during removal of the disc.

Special eyeglasses, called surgical
loupes, enhance the surgeon?s sight.

Recovery
Whether the treatment course is conservative or operative, it is important to closely follow the instructions of your physician and/or physical therapist.

Keep your weight close to ideal and continue to follow the exercise and/or rehabilitative program designed by your physical therapist at home.

Remember that most patients with a herniated disc will get better without surgery.

Posted on: May 21st, 2002
Last Updated on: February 1st, 2010

Peer Reviews by Leading Specialists

What is this?

Howard S. An, MD

Dr. Dawson's article on herniated disc is quite informative, and it has been written in such a way for a lay person to understand the content. The description on the extent of herniation is quite accurate and MRI is quite helpful in determining the type and location of herniated disc. It should be remembered that the diagnosis of a herniated disc is frequently made clinically after history and examination, and MRI or CT is recommended only if invasive treatment is considered.

Among conservative treatments mentioned, pain relief with nonsteroidal anti-inflammatory medications (NSAIDs) and a gradual exercise program rather than bedrest is important for maximal recovery.

Epidural steroids also should be mentioned as a secondary treatment for radicular pain if NSAIDs are not helping.

Surgical indications should be strictly defined as failure to relieve radicular pain or radiculopathy despite appropriate conservative treatment for at least 6 weeks, and imaging study showing herniated disc that correlates clinically.

Dr. Dawson is correct in that about 80-90% of patients with a herniated disc will respond to conservative treatment. One of the reasons for the patient's improvement of symptom associated with herniated discs is the tendency of gradual resorption of the extruded disc frament with time. If surgery is indicated, outpatient microdiscectomy is the gold standard treatment as Dr. Dawson stated.

Other treatment methods such as chemonycleolysis, endoscopic or arthroscopic discectomy, nucleoplasty, etc. have narrower indications, and the success rate is generally lower than microdiscectomy. Long-term outcomes following these newer procedures should be determined prior to general application.