- Symptoms experienced by the patient
- Age of the patient
- Activity level of the patient
- Presence of worsening symptoms
- Rest & Activity Modification
The first treatment is to rest and avoid activities that aggravate your symptoms. Many disc herniations will resolve is given time. In these cases, it is important to avoid activities that aggravate your symptoms.
- Ice & Heat Applications
Ice and heat application can be extremely helpful in relieving the painful symptoms of a disc herniation. By helping to relax the muscles of the back, ice and heat applications can relieve muscle spasm and provide significant pain relief.
- Physical Therapy
Physical therapy and lumbar stabilization exercises do not directly affect the herniated disc, but they can stabilize the lumbar spine muscles. This has an effect of decreasing the load experienced by the disc and vertebrae. Stronger, well balanced muscles help control the lumbar spine and minimize the risk or injury to the nerves and the disc.
- Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, and often help relieve the pain associated with a disc herniation. By reducing inflammation, these medications can relieve some pressure on the compressed nerves. NSAIDs should be used under your doctor's supervision.
- Oral Steroid Medications
Oral steroid medications can be very helpful in episodes of an acute (sudden) disc herniation. Medications used include Prednisone and Medrol. Like NSAIDs, these powerful anti-inflammatory medications reduce inflammation around the compressed nerves, thereby relieving symptoms.
- Other Medications
Other medications often used include narcotic pain medications and muscle relaxers. Narcotic pain medications are useful for severe, short-term pain management. Unfortunately, these medication can make you drowsy and can be addictive. It is important to use these for only brief periods of time. Muscle relaxers are used to treat spasm of spinal muscles often seen with disc herniations. Often the muscle spasm is worse than the pain from the disc pressing on the nerves.
- Epidural Steroid Injections
Injections of cortisone can be administered directly in the area of nerve compression. Like oral anti-inflammatory medications, the idea is to relieve the compression on the nerves. When the injection is used, the medication is delivered to the area of the disc herniation, rather than being taken orally and travelling throughout your body.
Is surgery necessary in the treatment of a disc herniation?
As mentioned, treatment of a disc herniation usually begins with the steps listed above. However, surgical treatment of a herniated disc may be recommended soon after the injury if there is a significant neurological deficit to your problem. Symptoms on pain and sensory abnormalities usually do not require immediate intervention, but patients who have significant weakness, any evidence of cauda equina syndrome, or a rapidly progressing problem may require more prompt surgical treatment.
Most often surgery is recommended if more conservative measures do not relieve your symptoms. Surgery is performed to remove the herniated disc, and free up space around the compressed nerve. Depending on the size and location of the herniated disc, and associated problems (such as spinal stenosis, arthritis, etc.), the surgery can be done by several techniques. In very straightforward cases, endoscopic or microscopic excision of the herniated disc may be possible. However, this is not always recommended, and in some cases, a more significant surgery may need to be performed.