From the Guidelines
Treatment for intervertebral disc disease should prioritize noninvasive management for the first 4 weeks, with options including pain management and physical therapy, before considering surgical interventions like discectomy or epidural steroid injection for persistent symptoms. When considering treatment options for intervertebral disc disease, it's crucial to evaluate the patient's symptoms and potential for surgery or epidural steroid injection, with MRI or CT scans recommended for those who are potential candidates for invasive interventions 1. The natural history of lumbar disc herniation with radiculopathy often shows improvement within the first 4 weeks with noninvasive management, suggesting that routine imaging may not be necessary unless there are signs of radiculopathy or spinal stenosis 1. Key considerations in treatment include:
- Noninvasive management for the initial 4 weeks
- Use of MRI or CT scans for evaluating patients with persistent back and leg pain who are potential candidates for invasive interventions
- Surgical options like discectomy for prolapsed lumbar disc with persistent radicular symptoms despite noninvasive therapy
- Epidural steroid injection as a potential treatment option for suspected radiculopathy
- The importance of clinical correlation between symptoms and radiographic findings in guiding treatment decisions 1. In terms of specific treatment approaches, the choice between conservative and surgical management depends on the severity of neurological deficits and the patient's response to initial noninvasive management, with patients showing significant neurological deficits or pain unresponsive to medication typically requiring more aggressive interventions 1.
From the Research
Treatment Options for Intervertebral Disc Disease
The treatment options for intervertebral disc disease can be categorized into conservative and surgical approaches.
- Conservative management includes:
- Epidural steroid injections: Studies have shown that epidural steroid injections can be effective in alleviating radicular symptoms from lumbar herniated discs 2, 3.
- Physical therapy and exercise: Stabilization exercises have been shown to be more effective than no treatment for patients with lumbar disc herniation and associated radiculopathy 4.
- Spinal manipulation: Manipulation has been shown to be more effective than sham manipulation for patients with acute symptoms and an intact anulus 4.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol may be used to manage pain and inflammation 5.
- Surgical options include:
Effectiveness of Treatment Options
The effectiveness of these treatment options can vary depending on the individual patient and the severity of their condition.
- Epidural steroid injections have been shown to be effective in improving pain and function in patients with lumbar disc herniation and associated radiculopathy, with significant improvement seen in 77% of patients at 1.5-year follow-up 2.
- Transforaminal epidural injections of local anesthetic with or without steroids have been shown to be effective in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis, with significant improvement seen in 65% of patients at 2-year follow-up 6.
- Spinal manipulation has been shown to be effective in improving pain and function in patients with lumbar disc herniation and associated radiculopathy, with moderate evidence favoring manipulation over sham manipulation 4.
Considerations for Treatment
When considering treatment options for intervertebral disc disease, it is essential to take into account the individual patient's needs and circumstances.
- Patients with inflammatory end-plate changes may benefit from spinal steroid injections, which have been shown to be more effective in this subgroup of patients 3.
- Patients with chronic low back pain may benefit from a multimodal rehabilitation approach that combines physical and psychological treatment 5.