Treatment. Disc Herniation

Herniated disc treatment

Treatment for disc herniation can go from nonsurgical to surgical. The treatment relies typically upon the level of pain you are encountering and how far the disc has slipped from its original place.

Herniated disc symptoms and pain can go away by participating in activities that extend and reinforce the back and connecting muscles. A physical specialist may prescribe practices to strengthen your back while decreasing your pain. Taking over-the-counter pain relievers and steering away from challenging work and agonizing positions can also offer assistance. While it might be enticing to avoid all physical movement while you are encountering the pain and inconvenience of a herniated disc, this can cause muscle spasms and joint stiffness. It would be better to stay as active as possible through exercises, for example, jogging.

If your herniated disc symptoms do not react to over-the-counter drugs, your specialist may recommend stronger drugs. These include:

• muscle relaxtants to relieve muscle pain and spasms
• narcotics to relieve pain
• pain medications like Gabapentin or Duloxetine for the nerves

Your specialist may suggest surgery if your symptoms do not relieve in a month and a half or if your herniated disc affects your muscles. Your physician may evacuate the harmed or jutting bit of the disc without expelling the whole disc. This is known as a microdiscectomy. In more extreme cases, your specialist may replace the disc with an artificial one or remove the disc and join your vertebrae together. This technique helps keep your spinal column stable.

Not every case of a herniated disc requires surgery. In fact, in most cases, herniated discs do not require surgical treatment. How a herniated disc is treated depends on the symptoms and whether they resolve or get more serious.

Your doctor is more likely to recommend surgery if your herniated disc symptoms are steadily becoming more severe. If your condition is improving, he may recommend a course of treatment that involves watching and waiting to see if your symptoms resolve. Many patients who experience problems because of a herniated disc when it first occurs find their symptoms completely go away over a period of several weeks or a few months.

Conservative treatment of herniated disc

If there are no signs of serious complications resulting from a herniated disc, doctors will often recommend conservative treatment of your symptoms. Conservative treatment of herniated disc includes:

• Observation: This involves watching your condition to ensure the herniated disc does not lead to other serious complications. If there are no indications of progressive weakness or numbness, and your pain is manageable, your physician may suggest watching and waiting. 
• Rest: If the herniated disc causes more significant pain, your activity may need to be decreased, and you may need a few days away from your job. After resting for several days, slowly start to increase your activity with gentle tasks such as walking and gradually increase your activity tolerance to see if your herniated disc symptoms worsen. 
• Pain medications: Depending on how severe your pain due to your herniated disc is, different analgesics (pain medications) can be used to help you feel more comfortable. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen can be purchased over-the-counter and help decrease inflammation and serve as a herniated disc pain relief. These drugs can cause stomach irritation, so they should be taken with food. If these medications are ineffective, your physician may prescribe a stronger medication for your herniated disc pain relief, such as narcotics, muscle relaxants, or other medications. Narcotic analgesics can become addictive, and many doctors will not prescribe these for more than a few weeks for herniated disc pain relief. 
• Epidural Steroid Injection (ESI): An injection of a steroid medication such as prednisone directly into the affected herniated disc area to decrease the pain and inflammation is usually only suggested in cases of severe pain or if surgery is quickly becoming the only other available treatment option. ESI is only effective as a pain control intervention about 50% of the time for herniated discs pain relief. 

Herniated disc surgery

Laminotomy and Discectomy

The most traditional surgical procedure for treating a herniated disc is laminotomy and discectomy. In this operation, an incision is made directly over the herniated disc in the back. The muscle tissues under the skin are moved so the doctor can see the backbones. It may be necessary to take X-rays during the procedure to ensure the correct vertebra and disc are chosen. A small incision is made between the two vertebrae where the herniated disc is located. This incision allows the surgeon to visualize the spinal canal. A small portion of the vertebra (the lamina) usually needs to be removed to make access to the spinal canal possible.

The surgeon then finds the gel-like disc material which has ruptured from the disc and removes it from the spinal canal. This will take the pressure and irritation off of the spine. He also removes as much of the material inside the disc to prevent it from leaking out again and causing another herniated disc episode. When the doctor is finished with the procedure, the muscles are replaced into position, and the skin incision is closed with metal staples or sutures. 

Microdiscectomy

This herniated disc surgery is the same as the traditional laminotomy and discectomy for herniated disc repair, however, the incision is much smaller. This means there is less injury to the unaffected parts of your spine during the procedure, and recovery may occur more rapidly. A tiny incision is made just over the herniated disc, and the muscles are moved aside as in the traditional procedure. Once the herniated disc is seen, an operating microscope is inserted and used to complete the operation. The remainder of the herniated disc procedure is completed using the same approach as the traditional method. 

Endoscopic Discectomy

In this herniated disc surgery, even smaller incisions are needed to insert special television cameras into the spinal canal so the surgeon can visualize the herniated disc material. Other special surgical instruments are also inserted through these small incisions, and the surgeon views the TV screen and guides the instruments to remove the herniated disc material. This procedure is not yet widely used to repair herniated discs and is still evolving. It is beneficial because the incisions required are tiny, so they do even less damage to tissues around the spine than microdiscectomy. This can mean fewer complications and faster recovery times from herniated disc surgery. 

Complications

During surgery

During any type of surgical procedure, there is always the risk of complications due to anesthesia. Possible complications during an operation for a herniated disc include:

• Nerve injury: Removal of herniated disc material involves working near the spinal nerves. During the procedure, the nerves may be damaged or injured. If this happens, you may suffer nerve damage, causing permanent weakness, numbness, or pain in the area the nerve travels. 
• Dural Tear: The spinal cord and the spinal nerves are covered with a water-tight bag of tissue called the dura mater. During herniated disc surgery, a tear can occur in this coverage, and it is not unusual for this to occur in any type of operation on the spine. If the tear is noticed during the herniated disc operation, it is repaired and usually heals without further complication. If it goes unnoticed during herniated disc surgery, the tear may not heal and can leak spinal fluid. Leakage of spinal fluid can result in problems such as spinal headaches and the risk of infection in the spinal fluid, called spinal meningitis. If the leak does not heal and seal itself on its own reasonably soon after herniated disc surgery, the tear in the dura may have to be surgically repaired. This would require a second operation. 

After surgery:

Some complications do not become apparent until after herniated disc surgery. Some become evident soon after your operation, and others may take months to show up. Post-surgical complications following herniated disc procedures include: 

• Infection: All surgical procedures carry some risk for infection, and herniated disc surgery on the spine is not an exception. Infection can develop around the nerves in the spinal canal, inside the affected herniated disc, or in the incision made in the skin. If the infection involves only the incision in your skin, the only treatment needed may be antibiotics. If the infection develops in the herniated disc area or the spinal canal, you may need further surgery to drain the infection in addition to antibiotics. 
• Re-herniation: There is about a 10-15% chance that the herniated disc operated on will herniate again. This usually occurs within the first six weeks following your surgery, but it may happen anytime. If this happens, you may need another herniated disc operation. 
• Persistent pain: Herniated disc surgery does not always eliminate pain. There are many reasons people continue to have pain despite back surgery. These reasons include: 
  • Complete recovery may not be possible if pressure caused by the herniated disc has damaged the nerves.
  • Scar tissue may form around the nerves following herniated disc pain relief surgery. This puts pressure on the nerves and causes pain similar to the pain caused by the herniated disc.
  • The herniated disc pain you were having prior to surgery may be from issues in addition to a disc herniation that was not solved by removing the herniated disc.
• Degenerative Disc Disease: Any time a disc is injured, the injury can lead to degeneration in that portion of the spine. A herniated disc that has been surgically altered can certainly be considered as “injured.” This places the surrounding area of the spine at increased risk for degenerative changes to occur. The degenerative process is prolonged, usually taking several years to occur, but if the changes caused by degeneration become severe, a second surgery may be needed. 

Herniated disc rehabilitation

Following your herniated disc pain relief operation, your physician will probably recommend physical therapy before you begin an exercise routine on your own. A skilled therapist will help you choose safe and effective exercises for your herniated disc rehabilitation as an individual. Exercise is essential to your herniated disc pain relief and maintaining your spine health over time. It is the easiest and most sensible way to combat problems with your back. Research has shown that exercise done regularly is linked to fewer back problems. It has many benefits for your spine health, including:

• Strengthening: It can help re-strengthen your core muscles that help support your spine following herniated disc pain relief surgery and also can strengthen the muscles of your arms and legs. Strength in your muscles reduces back strain.
• Exercise can reduce your risk of falling and sustaining injuries.
• Stretching exercises decrease the risk of painful spasms in the muscles.
• Weight-bearing exercise helps to prevent osteoporosis, which in turn decreases your risk of compression fractures that can cause pain similar to that of a herniated disc.
• Aerobic exercise, the kind that increases your heart rate, can help to relieve pain. It stimulates the body to release its own “feel good” chemicals, called endorphins.