From the Guidelines
Treatment for a herniated disc should initially focus on noninvasive management, with surgery considered only when symptoms persist despite conservative therapy. 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 typically includes remaining active, as it is more effective than resting in bed for patients with nonspecific low back pain 1.
Key components of conservative treatment include:
- Over-the-counter pain medications to reduce inflammation and discomfort
- Physical therapy focusing on core strengthening exercises and proper body mechanics
- Avoiding movements that cause pain
- Gradual return to normal activities
For patients with persistent radicular symptoms despite noninvasive therapy, discectomy or epidural steroids are potential treatment options 1. Surgery is also considered for persistent symptoms associated with spinal stenosis. It's crucial for clinicians to inform patients about the generally favorable prognosis of acute low back pain, including a high likelihood for substantial improvement in the first month 1.
Magnetic resonance imaging (MRI) or CT is recommended for evaluating patients with persistent back and leg pain who are potential candidates for invasive interventions 1. However, clinicians should be aware that findings on MRI or CT are often nonspecific and decisions should be based on the clinical correlation between symptoms and radiographic findings, severity of symptoms, patient preferences, surgical risks, and costs 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
- Epidural steroid injections have been shown to be effective in alleviating radicular symptoms from lumbar herniated discs, with a success rate of 77% in one study 3
- Surgical interventions should only be considered in special symptom constellations, and the decision to operate should be made after a thorough evaluation of the patient's condition 4
- The duration of conservative treatment before considering surgery is a topic of debate, but one study suggests that patients who undergo surgery within 2 months of symptom onset tend to have better outcomes 4
- A prospective cohort study found that surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up 5
Non-Surgical Management
- Conservative management options include paracetamol and anti-inflammatories to relieve pain, as well as physical therapy and exercise 6
- An interprofessional team is necessary to manage herniated disc patients efficiently, and primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues 6
- Regular exercise and maintaining a healthy body weight can enhance treatment outcomes 6
Surgical Intervention
- Surgery is sometimes the final option for patients with herniated discs, particularly those with neurological damage and lingering discomfort 6
- Standard open discectomy is a common surgical procedure for lumbar disc herniation, and has been shown to be effective in relieving back pain symptoms in some patients 5