From the Guidelines
Treatment for L5 disc herniation typically begins with conservative approaches before considering surgery. The initial management includes rest for 1-2 days, followed by a gradual return to activities while avoiding movements that worsen pain. Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) can reduce inflammation and discomfort 1. Physical therapy focusing on core strengthening exercises and proper body mechanics is crucial for recovery, usually recommended for 6-8 weeks. For more severe pain, prescription medications may include muscle relaxants like cyclobenzaprine (5-10mg three times daily) or stronger pain relievers such as tramadol (50-100mg every 4-6 hours) 1. Epidural steroid injections can provide temporary relief for persistent symptoms. Surgery becomes an option when conservative treatments fail after 6-12 weeks, or if there are progressive neurological deficits or severe pain. Microdiscectomy is the most common surgical procedure, involving removal of the herniated portion of the disc to relieve pressure on the nerve root. This targeted approach helps address the mechanical compression causing symptoms while preserving spinal stability and function 1.
Some key points to consider in the treatment of L5 disc herniation include:
- The natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management 1.
- There is no compelling evidence that routine imaging affects treatment decisions or improves outcomes 1.
- For prolapsed lumbar disc with persistent radicular symptoms despite noninvasive therapy, discectomy or epidural steroids are potential treatment options 1.
- Magnetic resonance imaging (preferred if available) or CT is recommended for evaluating patients with persistent back and leg pain who are potential candidates for invasive interventions—plain radiography cannot visualize discs or accurately evaluate the degree of spinal stenosis 1.
- Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options 1.
- General advice on self-management for nonspecific low back pain should include recommendations to remain active, which is more effective than resting in bed for patients with acute or subacute low back pain 1.
From the Research
Treatment Options for L5 Disc Herniation
The treatment for L5 disc herniation can be divided into nonoperative and operative methods.
- Nonoperative methods include:
- Operative methods include:
Nonoperative Treatment
Nonoperative treatment is often the first line of treatment for L5 disc herniation.
- A study published in 2021 found that nonoperative treatment, including oral analgesic medication, activity modification, and physical therapy, can be effective in managing symptoms 2.
- Another study published in 2016 found that gabapentin can provide fast and effective relief of pain caused by far lateral lumbar disc herniations 4.
- A study published in 2005 found that the 5-HT2A receptor inhibitor has the potential to alleviate symptoms in patients with lumbar disc herniation 5.
Operative Treatment
Operative treatment is considered when nonoperative treatment fails to provide adequate relief.
- A study published in 2004 found that discectomy is more effective than epidural steroid injection in reducing symptoms and disability associated with a large herniation of the lumbar disc 3.
- A study published in 1999 found that an extreme lateral approach for far lateral disc herniation can be a safe and effective technique with no disruption of spinal stability 6.