From the Guidelines
Treatment for intervertebral disc herniation should initially focus on noninvasive management, with discectomy or epidural steroids considered for patients with persistent radicular symptoms despite noninvasive 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. Key components of noninvasive management include:
- Providing patients with evidence-based information on low back pain, advising them to remain active, and informing them about effective self-care options 1
- Recommending patients to remain active, as this is more effective than resting in bed for patients with nonspecific low back pain 1
- Considering pain management medications and physical therapy, focusing on core strengthening exercises, proper body mechanics, and stretching routines
- Using magnetic resonance imaging (MRI) or CT scans to evaluate patients with persistent back and leg pain who are potential candidates for invasive interventions, while being aware that findings on MRI or CT are often nonspecific 1
For patients with persistent radicular symptoms despite noninvasive therapy, potential treatment options include:
- Discectomy
- Epidural steroids
- Surgery, which is also a treatment option for persistent symptoms associated with spinal stenosis 1 It is essential to base decisions on the clinical correlation between symptoms and radiographic findings, severity of symptoms, patient preferences, surgical risks, and costs, and to generally require specialist input 1.