Lumbar Disc Herniation Treatment Options
Degenerative disc disease is a leading cause of chronic low back pain as we age and seriously impacts quality of life. Genetics, environmental, biomechanical and anatomy variations are related to disc disease. Degenerative changes lead to the disc being less capable of maintaining its function of load distribution and shock absorption.
Most of the symptoms of lumbar disc herniation are short-lived and resolve within six to eight weeks with conservative/nonsurgical management. However, when a neurological examination reveals clear signs of abnormal function such as abnormal reflexes, decreased sensation, loss of balance, weakness, serious problems walking or cauda equina syndrome (loss of bowel and bladder function), surgery will be recommended. The goal of treatment is to diminish pain, improve function and reduce the risk of serious complications.
First line treatment is conservative nonsurgical management for acute lumbar disc herniation including a short course of rest, activity modification, ice and heat therapy for pain, physical therapy, and over the counter pain and anti-inflammatory medications. Opioids are not particularly effective for sciatica and rarely used. Epidural steroid injections may be recommended when symptoms persist longer than six weeks. In 80% of patients with a ruptured disc, surgery is not necessary.
Surgery is the last resort and will be offered when the patient has persistent and disabling symptoms that do not respond to nonsurgical treatment including
- sciatica or any pain that limits daily activities or impairs quality of life
- leg muscle weakness and/or numbness
- difficulty standing or walking
- loss of bowel and bladder control.
Your Dallas Neurosurgical & Spine specialist will discuss your surgical options with you taking into consideration your age, occupation and health. Surgery will be recommended within six months to a year after failure of nonsurgical treatment to achieve faster recovery and improved long-term outcomes.
There are several surgical procedures that may be open surgery or minimally invasive surgery accomplished with small incisions.
- Microdiscectomy – This is a minimally invasive procedure that is performed as an outpatient procedure. The goal is to take the pressure off of the spinal cord or nerve root. It is recommended to treat a single disc herniation and requires only a small incision at the level of the herniation. Surgery removes the part of the disc that is pressing on the nerve. When more than one disc is herniated, discectomy at additional levels may be employed. Recovery from microdiscectomy involves activity restrictions for the first six weeks to prevent disc herniation again. Success rates are very high.
- Laminotomy – in this surgery a small incision in made in the area of herniation and a portion of the vertebral bone called the lamina is removed to reach the damaged disc, which is then removed in a procedure called a discectomy. When the spine is unstable after a laminotomy, spinal fusion may be necessary to restore stability.
The neurosurgeons at Dallas Neurosurgical & Spine are exceptionally skilled and employ state-of-the-art minimally invasive procedures and techniques to help you get back to the life you love. Contact us to schedule a consultation today.