From the Research
A patient with a minimal concentric disc bulge and broad-based central disc protrusion causing mild foraminal stenosis should initially be treated with conservative management. This approach is recommended because mild foraminal stenosis often responds well to non-surgical interventions, and the natural history of disc bulges frequently shows improvement over time as inflammation subsides and the body adapts to the structural changes 1.
Initial Treatment
Start with a short course of NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation. Combine this with physical therapy focusing on core strengthening and spine stabilization exercises for 6-8 weeks. Muscle relaxants like cyclobenzaprine (5-10mg at bedtime) may help with associated muscle spasms for short-term use (1-2 weeks). For pain management, acetaminophen (up to 3000mg daily in divided doses) can be used.
Alternative Therapies
Yoga therapy has also been shown to be safe and beneficial for patients with nonspecific low back pain or sciatica accompanied by disc extrusions and bulges, with significant improvement in disability scores 2.
Further Interventions
If conservative treatment fails after 6-8 weeks, consider epidural steroid injections. Transforaminal epidural injections of local anesthetic with or without steroids might be an effective therapy for patients with disc herniation or radiculitis, with significant improvement in pain and function seen in a majority of patients at 2-year follow-up 3.
Surgical Consideration
Surgery is rarely needed for mild stenosis and should only be considered if there is progressive neurological deficit or intractable pain despite comprehensive conservative management. Many cervical disc herniations can be successfully managed with aggressive nonsurgical treatment, and high patient satisfaction with nonoperative care can be achieved 4.
Natural History
It's also important to note that degenerative disc disease is a common finding in asymptomatic adults, increasing in frequency with age, and often involves more than one level, with the most common location being L5-S1 1. This highlights the importance of considering the patient's overall clinical picture rather than just the imaging findings when making treatment decisions.