Lumbar Disc Herniation Treatment Options

A lumbar disc herniation, also known as a slipped disc or a ruptured disc, occurs when the soft inner portion of the disc pushes out through the tough outer layer. This can irritate nearby nerves and result in pain, numbness, or weakness in one or both of the legs. A herniated lumbar disc is the most common cause of low back pain with sciatica.

Conservative non-surgical treatment

This is usually the first line treatment for a herniated lumbar disc.

1. Rest and Activity Modification: Taking a break from activities that exacerbate the symptoms and avoiding heavy lifting or strenuous movements that may worsen the condition. Bed rest should be limited to one or two days. Also avoid sitting for long periods.
2. Pain Medications: Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation, and muscle relaxants can relieve muscle spasms. Prescription strength NSAIDS or a short course of oral steroids may be needed do alleviate pain and reduce inflammation. Short term use of opioids may be considered when other drugs fail to provide relief, or as a bridge to surgery.
3. Neuropathic Drugs: These medications affect nerve impulses and can help to decrease pain due to nerve irritation. They include gabapentin, Lyricaâ, Cymbaltaâ and Effexorâ.
4. Physical Therapy: Targeted exercises and stretches to strengthen the core muscles, improve flexibility, and relieve pressure on the affected disc. This can also include techniques like chiropractic therapy, traction, massage or manual therapy.
5. Heat and Cold Therapy: Applying heat packs or ice packs to the affected area to help reduce pain and inflammation.
6. Epidural Steroid Injections: Injecting corticosteroids directly into the space around the affected nerves to reduce inflammation and provide pain relief.

Surgery

When conservative treatments fail to improve symptoms and especially when there is difficulty standing and walking, loss of bowel or bladder control or numbness and weakness, surgery must be considered.

The primary goal of surgery for a herniated disc is to alleviate symptoms by relieving pressure on the spinal nerves or spinal cord. This is typically achieved by removing the portion of the disc that is causing the pressure. In some cases, this might involve removing the entire disc.  The intention is to preserve as much of the healthy disc as possible, as the discs serve a crucial role in the spine, providing cushioning and allowing for movement.

Surgical treatment options include:

• Microdiscectomy: This is a minimally invasive surgery often recommended for herniated discs causing symptoms of sciatica. During the procedure, a surgeon makes a small incision and uses a special microscope to view the disc and nerves. The damaged portion of the disc and any fragments pressing on the spinal nerves are removed. Microdiscectomy is a common procedure for a herniated lumbar disc that provides good results.
• Endoscopic Discectomy: This is a minimally invasive procedure that uses specialized instruments such as an endoscope which is inserted through a small incision to the affected area. Under fluoroscopy (real time x-rays) the instrument is guided to remove the herniated disc material by suction or other instruments.

  Endoscopic discectomy is considered a minimally invasive procedure because it involves smaller incisions, less tissue disruption, and generally results in a quicker recovery compared to traditional open surgeries. It aims to relieve pressure on the affected nerve and alleviate symptoms associated with lumbar disc herniation, such as back pain, leg pain, and numbness. However, it is not suitable for all herniated discs.

• Laminectomy/Laminotomy: These procedures involve removing part of the lamina, the bone that forms the backside of the spinal canal and forms a cover over the spinal cord. In a laminectomy, the entire lamina is removed. In a laminotomy, just a portion is removed. These procedures can help relieve nerve pressure caused by herniated discs, spinal stenosis, or both.
• Foraminotomy: This procedure is used to relieve pressure on nerves that are being compressed as they exit the spinal column. It can be done alone or along with a laminotomy or laminectomy.
• Spinal fusion: In this procedure, two or more vertebrae are permanently connected with a bone graft, screws, and rods. This limits the movement between the vertebrae. This is typically done in more severe cases or when there are issues with the stability of the spine.
• Artificial disc replacement: This is a relatively new procedure and is not as common. It involves removing the damaged disc and replacing it with an artificial one. The goal is to maintain spine mobility and height between the vertebrae.

It’s important to have a thorough discussion with a Dallas Neurosurgical & Spine neurosurgeon who can review your imaging and symptoms and discuss the best treatment options for you. Our goal is to perform the least invasive, most effective procedures available tailored to your needs. We have offices in Plano, Frisco, and Dallas and offer virtual visits as well.