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Herniated Disc |  | | By Ashok Anant MD |
The initial treatment for a herniated disc is usually conservative, i.e. nonoperative. One usually begins with resting the low back area, maintaining a comfortable posture and painless activity level for a few days to several weeks. This in in order to allow the spinal nerve inflammation to quiet down and resolve.
A herniated disc is frequently aided by non-steroidal anti-inflammatory medication such as Motrin, Voltaren, Naprosyn, Lodine, Feldene, Clinoril, Tolectin, Dolobid, Advil or Nuprin. An epidural steroid injection may be performed utilizing a spinal needle under x-ray guidance to direct the medication to the exact level of the disc herniation.
Physical therapy may be beneficial, under the direction of a physical therapist. The therapist will perform an in-depth evaluation; this information, combined with a physician's diagnosis, will dictate a treatment based on successful physical therapy treatment modalities which have proven beneficial for herniated disc patients. These may include traction, ultrasound, electrical muscle stimulation, etc., to relax the muscles which are in spasm and secondarily inflamed from the compressed spinal nerve. Pain medication and muscle relaxing medications may also be beneficial to help physical therapy or other conservative, non-operative treatment to relieve the pain while the spinal nerve root inflammation resolves and the body heals itself. If these conservative treatments are not successful and the pain is still severe or muscle weakness is increasing, then surgery is necessary. Surgery may be in the form of a percutaneous discectomy if the disc herniation is small and not a completely extruded disc fragment.
If the herniation is large, or is a "free fragment" as described above, then a microlaminotomy with disc excision is necessary. A micro-laminotomy requires one to two days of hospitalization after the surgery for the wound to heal and postoperative physical therapy to begin. The sciatic pain down the leg should be resolved immediately after the surgery. However, there will be some discomfort in the low back area where the operation is performed, lasting several days to a couple of weeks. This is controlled with pain medication.
Prognosis
A person who has sustained one disc herniation is statistically at increased risk for experiencing another. There is an approximate 5% rate of recurrent disc herniation at the same level, and a lesser incidence of new disc herniation at another level. Factors involved may be weight related level of physical conditioning, work or behavioral habits. Since these factors are typically the same after surgery, there is an increased risk of herniated disc in this group, over the general population.
However, the good news is that the majority of disc herniations (90%) do not require surgery, and will resolve with conservative, nonoperative treatment, without significant long-term sequelae. Unfortunately, approximately 5% of patients with herniated, degenerated discs will go on to experience symptomatic or severe and incapacitating low back pain which significantly affects their life activities and work. This unfortunate result is not always specifically the result of surgery. The causes of this unremitting pain are not always clear or agreed on, and my be from several sources. When this occurs, the prognosis is poor for returning to normal life activities regardless of age.
After a successful laminotomy and discectomy, 80-85% of patients do extremely well and are able to return to their normal job in approximately six weeks time. There may be small permanent patches of numbness in the involved leg which, fortunately, are not disabling. Flare-ups or exacerbations of less severe and less significant sciatic type pain may develop in the future (usually on an infrequent basis).
Recommendations
Our advice to those who have herniated disc disease is to become knowledgeable in back school lifting techniques and activity modifications from your physical therapist. Making your back strong through exercises performed for approximately 30 minutes daily will restore normal flexibility in the lumbar spine region, as well as strengthen muscles which can resist strain and repeat injury. Always avoid heavy lifting, especially in association with twisting of the lumbar spine. Protect your back for at least nine months to a year after sustaining the herniated disc.
Feel free to consult your physical therapist for more specific recommendations regarding postoperative or post-herniated disc lumbar spine reconditioning and maintaining a well-conditioned spine. |
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Manhattan Neurosurgical Associates, P.C.: Manhattan Neurosurgical Associates: Handout
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