BY MARK WANG, MD
Dr. Mark Wang is a fellowship-trained and board-certified orthopedic spine surgeon. He dedicates his full attention to working together with his patients to identify their pain source and find the least invasive treatment that works for them.
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Up to 2% of adultsin the United States experience herniated discs annually. That number may seem small at first glance, but it accounts for almost 7 million people! If you experience a herniated disc, you are likely familiar with the frustrations and pains this condition can cause. As you deal with the troubles of a herniated disc, it is common to wonder if your herniated disc can be fixed without surgery.
Fortunately, doctors have many options to treat a herniated disc before surgery. If surgery is necessary, there are many minimally invasive treatment options for a bulging or herniated disc. We’ve compiled 11 different treatment options for herniated discs to show how doctors treat this condition.
Non-Surgical Treatments for a Herniated Disc
Approximately70% to 80% of individualswill experience lower back pain at some point, but most do not need surgery. The same applies to herniated discs. Here are some common non-surgical treatments for a herniated disc that your doctor will pursue before surgery.
1. Physical Therapy
In the past, medical advice for herniated discs was torest in bed for one to two weeks. Medical doctors have since shifted their stance, agreeing that staying active isfar more essential to your body’s ability to recover. While some rest is acceptable and necessary, you should try to be active as much as possible.
It can be confusing to know how much activity is enough or too much on your own. A physical therapist (PT) can help you understand how much you should be exercising. They will:
- Track your activity levels.
- Provide muscle strengthening exercises.
- Increase your flexibility.
- Help you recover without aggravating your injury.
Physical therapyconsists of active and passive exercises. Some passive exercises you may encounter with physical therapy for a herniated disc include:
Deep tissue massage
As the name suggests, deep tissue massage (DTM) works the deep layers of muscles with slow and firm strokes. The increased pressure with DTM enhances circulation, decreases inflammation and reduces muscle spasms. Another type of massage you may experience with physical therapy is soft tissue mobilization (STM). STM applies a range of pressures, depths and durations.
Traction therapy
PTs use traction therapy to stretch soft tissues and relieve pressure on joints or bones. Traction therapy for herniated discs aims to reduce the hernia by gently stretching the spinal cord.
Transcutaneous electrical nerve stimulation (TENS)
With TENS, PTs use a TENS machine to deliver electrical currents to targeted muscles and nerves. The electrical currents stimulate your nerves to release endorphins — your body’s natural painkillers.
Whereas passive exercises contract and relax muscles through an outside force, active exercises require you to contract and relax your muscles directly. Here are some examples of active exercises:
Aerobic exercises
Aerobic exercise helps herniated discs by increasing blood flow to the spine and reducing stiffness. For herniated discs, low-impact aerobic exercise is best. Some examples of aerobic exercises for herniated discs include swimming, cycling or brisk walking.
Strengthening exercises
PTs will encourage you to do core and back muscle strengthening exercises. Stronger core and back muscles support your body weight and bones to take pressure off your spine.
Stretching exercises
Flexibility is essential to succeed in physical therapy. It also helps prevent muscle stiffness. PTs focus on stretching exercises to reduce back stiffness and keep you flexible enough to do the strengthening and aerobic exercises.
2. Hot and Cold Therapy
Alternating hot and cold therapyon herniated discs has a two-fold effect. Cold therapy reduces inflammation and relieves pain. In contrast, hot therapy enhances circulation and promotes healing. As hot and cold are opposites, each therapy’s effect on herniated discs is also opposing. As such, you should start with cold therapy. Then, when the cold therapy has relieved your pain to your satisfaction, apply some heat to increase blood flow and accelerate healing.
3. Alternative Therapies
Various alternative therapies also have pain-relieving and limited healing benefits for herniated discs. These include:
Acupuncture
Acupuncture is rooted in ancient Chinese medical practice, based on the belief that every person has an energy force known as Qi — pronounced “chee.”
Pain and illness occur with an imbalanced energy force. Acupuncture corrects this imbalance by sticking thin needles into strategic spots to free up Qi channels.
Although the Western explanation of acupuncture differs,its pain-relieving benefits are evidence-supported.
Some explanations for how acupuncture works includeendorphin release and increased circulation.
Chiropractic care
Chiropractors can help with herniated discsthrough spinal manipulation. After evaluating your spine, a chiropractor will adjust it to bring it into proper alignment and relieve pressure on the disc and nerves.
4. Medications
Your doctor may recommend over-the-counter (OTC) or prescription-grade medications for herniated disc pain. If your pain is severe, they may pursue prescription medication as a first-order treatment. If the pain is mild or manageable, they may recommend OTC medications to help with soreness after PT or other herniated disc treatments. Some OTC medications for relieving herniated disc pain include:
Acetaminophen:
Best known under the brand nameTylenol, acetaminophen relieves pain but does not reduce inflammation. For a herniated disc, acetaminophen is acceptable in a pinch but not optimal as it masks the pain without decreasing swelling. Without reduced inflammation, the temporary pain relief can increase your risk of aggravating the herniated disc.
Non-steroidal anti-inflammatory drugs (NSAIDs):
NSAIDs include ibuprofen (Advil), naproxen (Aleve) and acetylsalicylic acid (aspirin). They are better than Tylenol for herniated discs as they reduce inflammation and relieve pain, reducing the risk of further injury. If you cannot take NSAIDs for medical reasons, Tylenol can work to alleviate pain when necessary.
For significant herniated disc pain, your doctor may prescribe one or more of these medications:
Anticonvulsants:
Although doctors primarily prescribe anticonvulsants for epilepsy, the Food and Drug Administration (FDA) also approves them for treating nerve pain. If your herniated disc causes sciatica pain, your doctor may prescribe an anticonvulsant. Some side effects of anticonvulsants include fatigue and drowsiness.
Antidepressants:
Doctors often prescribe tricyclic antidepressants to treat chronic back pain. When you take certain antidepressants over several weeks, theyincrease neurotransmitters in your spine that relieve pain.
Muscle relaxants:
Due to their addictive quality, muscle relaxants like benzodiazepines are best suited for treating severe acute pain from herniated discs. They provide significant pain relief by relaxing your muscles.
Opioids:
As with muscle relaxants, doctors only prescribe opioids for severe back pain. They provide powerful pain relief but are also highly addictive. You should only take opioids under close medical supervision. Opioids help with pain relief by releasing endorphins thatsuppress pain perception and boost feelings of pleasure.
Steroids:
Steroids are excellent for reducing inflammation. However, they can increase your risk of various medical conditions when taken in excess. So doctors prescribe steroids with discretion.
5. Selective Nerve Root Blocks
A selective nerve root block (SNRB) is a minimally invasive injection that interrupts pain signals between your spinal nerves and brain. Nerve root block injections contain a local anesthetic and sometimes a corticosteroid to reduce inflammation and relieve pain. The nerve root block has two purposes – diagnostically if the nerve root block relieves the patient’s pain, it confirms the nerve root is causing the pain. Therapeutically, the nerve root block can provide some therapeutic relief to the patient.
To perform an SNRB, doctors inject the steroid-anesthetic mixturearound or beside the neural sheathof the nerve root. A neural sheath is the connective tissue around each nerve, while a nerve root is the point where each nerve exits the spine. Doctors use fluoroscopy — X-ray guidance — and a contrast dye to ensure they inject the SNRB into the desired area.
The steroids inSNRBs inhibit the production of arachidonic acid, which leads toinflammation development and pain amplification. The local anesthetic blocks pain signals between the affected nerve and your brain. Although SNRBs are primarily diagnostic procedures, they also have therapeutic benefits. For disc herniation pain relief, SNRBs have reportedsuccess rates of around 75% for up to one year.
6. Epidural Steroid Injections
Epidural steroid injections unlike nerve root blocks typically do not include a local anesthetic into the epidural space thatseparates your spinal column from the protective dura matter layer. ESIs also can also be used to target painful nerve roots. The ESI procedure is minimally invasive and uses fluoroscopic guidance. Like SNRBs, doctors can administer ESIs for therapeutic and diagnostic purposes. Success rates for ESI intreating disc herniations are between 76% and 88%. Results can provide short-term or in some patients long-term relief.
Surgical Treatments for a Herniated Disc
For a herniated disc, doctors prefer non-surgical treatments over surgery whenever possible. If surgery is necessary, they will opt for the most minimally invasive option with the highest chance of success, given your condition. Your doctor may recommend surgery if you have:
- Difficulty standing or walking.
- Insufficient pain and symptom relief from non-surgical treatments.
- Pain that persists for six weeks or more.
- Symptoms have a significantly negative effect on your mental health.
Here are some common surgical options for treating a herniated disc.
7. Microdiscectomy
Amicrodiscectomyis a minimally invasive spinal surgery thataccounts for approximately 90% of herniated disc surgeries. The goal of any microdiscectomy is to remove the herniated part of a disc to relieve pressure on your spinal nerves. Even though microdiscectomies are minimally invasive, doctors rarely recommend surgery to patients early in their treatment path. They may recommend a microdiscectomy if you experience:
- Leg pain that persists longer than six weeks.
- Loss of bladder or bowel function.
- Sciatica as a primary symptom, rather than lower back pain only.
- Severe pain, tingling or weakness.
A microdiscectomy is usually an outpatient procedure. As such, patients can return home onthe same day of the surgery. Most patients can resume light activity after one or two weeks but should avoid lifting heavy objects for two to four weeks. You can expect a full recovery from a microdiscectomy six weeks after the procedure.
8. Lumbar Laminectomy
A lumbar laminectomy is a surgery that removes part or all of the lamina — part of your vertebral bones that forms the walls of your spinal canal. When spinal surgeons perform a lumbar laminectomy for a herniated disc, they do so to relieve pressure on the spinal cord or nerve roots. Thus, this surgery is only necessary for severe back and leg pain or when the surgeon needs to remove part of the lamina to access the herniated disc.
A traditional, open laminectomy involves lengthy recovery times and weakens spinal mobility. After traditional laminectomy, patients spend an average ofthree to five days in the hospital. It takes anywhere fromthree months to one yearto experience complete healing in your spinal bones.
In contrast, amicroscopic laminectomy is minimally invasive, shortening recovery times and minimizing damage to adjacent spinal structures. The recovery time for a microscopic laminectomy is around six weeks, and patients can return home the same day.
9. Spinal Fusion
Spinal fusion is a surgery to join two or more bones in your spine. Although spinal fusion is generally effective at reducing painful motion of disc problems, it can limit mobility in the spine. Doctors rarely pursue spinal fusion for herniated disc treatment. They may pursue spinal fusion if the pain is severe and less invasive surgeries are unlikely to reduce the pain. Recovery from spinal fusiontakes six weeks to six months, depending on your age and health.
10. Artificial Disc Replacement
Artificial disc replacement (ADR) surgery is a relatively new treatment for spinal disc-related conditions like degenerative disc disease or herniated discs.Introduced to the medical world in 2004, ADR is touted as a spinal fusion alternative.
Whereas spinal fusion limits mobility,ADR intends to preserve movementin your spine while also keeping it stable. With ADR, spinal surgeons replace a degenerated or bulging disc with an artificial one made of metal or plastic.
As ADR only works on certain discs in your lower back, it is only viable for patients needing lumbar herniated disc treatment. However, artificial cervical disc replacement (ACDR) also works on herniated discs in your neck.
An ADR procedure takes approximately two to three hours to complete, with most patients staying in the hospital forone to three days after the surgery. Most patients recover from anADR procedure within three months.
11. Endoscopic Foraminoplasty
Endoscopic foraminoplastyis one of the least invasive spine surgeries for a herniated disc. An endoscopic foraminoplasty can relieve herniated disc pain by freeing the nerves inside your foramen — the hollow boney tunnel which your spinal cord exits out to your arms in the neck or legs in the lower back. If your herniated disc puts significant pressure on the traversing or exiting nerve in the foramen, your doctor may recommend an endoscopic foraminoplasty. Most patients can return to work within one to two weeks of an endoscopic foraminoplasty.
How Are Herniated Discs Diagnosed?
Doctors diagnose herniated discs through a physical examination and various diagnostic tests. The first step in a herniated disc diagnosis is the physical examination. Your doctor will evaluate your pain, reflexes, muscle strength and sensation during this examination. They may also ask you to rate your pain on a scale of one to 10 and answer various questions about your symptoms, such as:
- When did they start?
- What triggers them?
- What kind of symptoms do you experience?
Depending on the results of your physical, your doctor may confirm or deny a herniated disc diagnosis if they feel they have enough information. Otherwise, they will order further testing. Some diagnostic tests that your doctor may recommend to diagnose a herniated disc include:
Computed tomography (CT) scan:
A CT scan is an advanced X-ray that illuminates the bones in your spine and detects herniated discs if they move into the space around your spinal cord. This test may be combined with a myelogram, which involves injecting dye into the spine to locate a herniated disc and detect spinal canal narrowing.
Electromyogram (EMG):
An EMG evaluates your nerve function and can identify the specific nerve that a herniated disc affects.
Magnetic resonance imaging (MRI):
An MRI is the most common and accurate imaging test for detecting a herniated disc.
X-rays:
An X-ray can rule out other causes of your back or neck pain.
Find Herniated Disc Relief With DISC
Desert Institute for Spine Care (DISC) is a leader in minimally invasive spine surgeries and treatments. Our spine specialists and surgeons have years of experience and success in relieving herniated disc pain for patients without resorting to invasive surgical options. For a consultation with one of our spine specialists or to learn more about your treatment options, we welcome you tocontact us today!
