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.
