What is the treatment for posterior disc derangement?

From the Guidelines

Treatment for posterior disc derangement should initially focus on noninvasive management, including rest, activity modification, and anti-inflammatory medications, with consideration for surgical intervention or epidural steroid injection if symptoms persist, as recommended by the American College of Physicians and the American Pain Society 1.

Key Considerations

• The natural history of lumbar disc herniation with radiculopathy often shows improvement within the first 4 weeks with noninvasive management 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, as it provides better visualization of soft tissue, vertebral marrow, and the spinal canal 1.
• Clinicians should inform patients of the generally favorable prognosis of acute low back pain and advise them to remain active, as this is more effective than resting in bed for patients with acute or subacute low back pain 1.

Treatment Approach

• Initial management: rest, activity modification, and anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain.
• Physical therapy: essential and should include exercises that promote anterior disc repositioning.
• For patients with significant pain, muscle relaxants like cyclobenzaprine (5-10mg at bedtime) may provide temporary relief.
• If conservative measures fail after 3-6 months, more invasive options like discectomy, epidural steroids, or surgery may be considered for persistent symptoms associated with spinal stenosis or radiculopathy 1.

Important Notes

• 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.
• Recommendations for specific invasive interventions, interpretation of radiographic findings, and additional work-up are beyond the scope of general practice and will generally require specialist input 1.

From the Research

Treatment for Posterior Disc Derangement

• The treatment for posterior disc derangement is not explicitly stated in the provided studies, but we can look at the treatment options for similar conditions such as internal derangements of the temporomandibular joint and discogenic low back pain.
• For internal derangements of the temporomandibular joint, management usually ranges from patient education and monitoring to splints, physical therapy, and medications 2.
• In some cases, surgery may be necessary, but the prognosis is generally good with conservative care 2.
• For discogenic low back pain, treatment modalities include noninvasive treatments such as drug therapy, physical modalities, and multidisciplinary biopsychosocial rehabilitation; interventional modalities such as intradiscal therapies and epidural injections; and regenerative modalities with disc injections of various solutions 3.
• The evidence for these treatment modalities varies, with limited evidence for drug therapy and intradiscal therapies, moderate evidence for multidisciplinary biopsychosocial rehabilitation and epidural injections, and poor evidence for regenerative therapies 3.
• Other treatment options such as McKenzie diagnosis and therapy, spinal mobilization, and spinal manipulation have been shown to be effective in resolving lumbar disc derangement syndrome in some cases 4.
• Percutaneous treatment of cervical and lumbar herniated disc is also a viable option, with a success rate of 75-94% and a mean complications rate of >0.5% 5.