From the Guidelines
Treatment for a herniated disc should initially focus on conservative management, including noninvasive methods, before considering surgical interventions. The natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management 1. This approach is supported by moderate-quality evidence, emphasizing the importance of avoiding routine imaging unless necessary for evaluating patients with persistent back and leg pain who are potential candidates for invasive interventions 1.
Conservative Management
Conservative management options include:
- Remaining active, as this is more effective than resting in bed for patients with nonspecific low back pain 1
- Over-the-counter pain medications
- Physical therapy focusing on specific exercises to strengthen core and back muscles
- Epidural steroid injections for temporary relief in cases where medication is not effective
Surgical Interventions
For prolapsed lumbar disc with persistent radicular symptoms despite noninvasive therapy, discectomy or epidural steroids are potential treatment options 1. Surgery is also a consideration for persistent symptoms associated with spinal stenosis. However, decisions regarding invasive interventions should be based on the clinical correlation between symptoms and radiographic findings, severity of symptoms, patient preferences, surgical risks, and costs, generally requiring specialist input 1.
Diagnostic Imaging
Magnetic resonance imaging (MRI) or CT is recommended for evaluating patients with persistent back and leg pain who are potential candidates for invasive interventions, as plain radiography cannot visualize discs or accurately evaluate the degree of spinal stenosis 1. However, clinicians should be aware that findings on MRI or CT are often nonspecific, and treatment decisions should consider the clinical context and patient-specific factors 1.
From the Research
Treatment Options for Herniated Disc
- Conservative therapy methods are usually used as the first treatment option for herniated discs, and may include physiotherapy, drug treatment, manual therapy, and injection therapies 2
- The combination of different treatment approaches can improve treatment outcomes for herniated discs 2
- Conservative treatment methods have been shown to lead to a significant reduction in pain and improvement in functional abilities in the majority of patients with herniated discs 2
Surgical Intervention
- Surgical interventions should only be considered in special symptom constellations, such as when conservative treatment has failed or when there is significant neurological damage 2, 3
- Patients who undergo surgery within 2 months of the onset of symptoms and sensory deficits may have better outcomes than those who wait longer 3
- Surgical treatment can provide faster relief from back pain symptoms in patients with lumbar disc herniation, but may not show a benefit over conservative treatment in midterm and long-term follow-up 4
Management and Evaluation
- The management of lumbar disc herniation typically involves a conservative approach, with paracetamol and anti-inflammatories being frequently used to relieve pain 5
- An interprofessional team is needed to manage disc herniation efficiently, and may include primary care physicians, nurse practitioners, and physical therapists 5
- Regular exercise and maintaining a healthy body weight can enhance treatment outcomes for herniated discs 5
- MRI interpretation may be necessary in cases where physical treatment is not working, and primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues 5